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Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated meta-analysis |
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| Authors: | Angelini Filippo Fortuni Federico Tsivgoulis Georgios Agnelli Giancarlo Bocchino Pier Paolo Franchin Luca De Filippo Ovidio Bellettini Matteo D’Ascenzo Fabrizio Crimi Gabriele Leonardi Sergio De Ferrari Gaetano M. Paciaroni Maurizio |
| Affiliation: | 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 ; |
| 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. MethodsWe 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. ResultsA 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). ConclusionsOAC 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. |
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