Stroke Prevention in Patients with Patent Foramen Ovale.

Journal Article (Journal Article;Review)

PURPOSE OF REVIEW: Patent foramen ovale (PFO) is widely prevalent and studies have suggested an association with ischemic stroke. In this review, we aim to highlight current management of patients with ischemic stroke in the setting of PFO and discuss some areas of controversy. RECENT FINDINGS: Upon reviewing the literature, we have found that the evidence regarding the management of patients with cryptogenic stroke and PFO has come a long way in the past several years, and many uncertainties remain in clinical practice. The Risk of Paradoxical Embolism (RoPE) score helps to predict the probability of a pathogenic PFO, and recent trial data confirms the benefit of closure in carefully selected patients. The benefit of closure in older patients and in patients with alternate, competing mechanisms is still uncertain, and the long-term risks of closure are not known. Finally, the efficacy of direct oral anticoagulants (DOACs) in this patient population as compared to other medical therapy or mechanical closure has not yet been investigated. Randomized data is needed to help answer these questions. PFO closure is a safe and effective strategy in reducing stroke risk in carefully selected patients with cryptogenic stroke in the setting of a PFO. More studies are needed to test optimal medical treatment strategies and the safety and efficacy of PFO closure in patient subgroups not included in prior PFO closure trials.

Full Text

Duke Authors

Cited Authors

  • Thaler, A; Kvernland, A; Kelly, S; Song, C; Aparicio, HJ; Mac Grory, B; Yaghi, S

Published Date

  • October 30, 2021

Published In

Volume / Issue

  • 23 / 12

Start / End Page

  • 183 -

PubMed ID

  • 34718891

Electronic International Standard Serial Number (EISSN)

  • 1534-3170

Digital Object Identifier (DOI)

  • 10.1007/s11886-021-01605-0


  • eng

Conference Location

  • United States