Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated meta-an
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ORIGINAL ARTICLE
Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated meta-analysis Filippo Angelini 1 & Federico Fortuni 2 & Georgios Tsivgoulis 3,4 & Giancarlo Agnelli 5 & Pier Paolo Bocchino 1 & Luca Franchin 1 & Ovidio De Filippo 1 & Matteo Bellettini 1 & Fabrizio D’Ascenzo 1 & Gabriele Crimi 2 & Sergio Leonardi 2,6 & Gaetano M. De Ferrari 1 & Maurizio Paciaroni 5 Accepted: 27 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Patients with patent foramen ovale (PFO) and cryptogenic ischemic stroke (CS) are at risk for stroke recurrence. The optimal antithrombotic strategy in patients who undergo medical management is still debated. Methods We systematically searched the literature for studies that reported on cerebrovascular event recurrences and/or death in patients with PFO treated with oral anticoagulation (OAC) or antiplatelet therapy (APT) for secondary prevention of CS. The efficacy endpoints were stroke recurrence and the composite of stroke, transient ischemic attack or all-cause death. Major bleedings represented the safety endpoint. Results A total of 16 studies with 3953 patients (OAC = 1527, APT = 2426) were included. Weighted mean follow-up was 2.9 years. OAC was associated with a significant reduction in the risk of stroke compared with APT (RR 0.65; 95% CI 0.44–0.95; ARR 2%, NNT 49), while no difference was found regarding the composite outcome (RR 0.78; 95% CI 0.57–1.07) and the safety outcome (RR 1.57; 95% CI 0.85–2.90; p = 0.15). Conclusions OAC was more effective than APT in reducing the risk of stroke recurrence in patients with PFO and CS, without a significant increase in the risk of major bleedings. Our findings support the need for further randomized data focused on the comparison of antithrombotic strategies in this setting. Keywords PFO . Anticoagulant . Antiplatelet . Stroke
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07068-9) contains supplementary material, which is available to authorized users. * Filippo Angelini [email protected] 1
Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Torino, Italy
2
Division of Cardiology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
3
Second Department of Neurology, School of Medicine, “Attikon” University Hospital, National & Kapodistrian University of Athens, Athens, Greece
4
Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN, USA
5
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia Italy
6
Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Introduction One third of ischemic strokes are cryptogenic [1]. Patent foramen ovale (PFO) occurs in more than 25% of the overall populati
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