Patent foramen ovale closure or medical therapy for secondary prevention of cryptogenic stroke: An update meta-analysis of randomized controlled trials.

Abstract

BACKGROUND:

It was under debate whether cryptogenic stroke patients benefited from patent foramen ovale (PFO) closure. We sought to determine secondary prevention strategy in these patients.

METHODS:

Scientific databases were searched for randomized controlled trials enrolling cryptogenic stroke patients with PFO who underwent PFO closure or medical therapy. The random-effect model was used to analyze the outcomes.

RESULTS:

We identified 6 trials enrolling 3630 participants in this meta-analysis. When compared with medical therapy, PFO closure reduced risks of recurrent stroke (risk ratio [RR] 0.52, 95% confidence interval [CI] 0.29-0.93) and composite of stroke and transient ischemic attack (TIA) (RR 0.60, 95% CI 0.46-0.80). And no differences in all-cause death (RR 0.80, 95% CI 0.37-1.72) and cardiovascular death (RR 1.47, 95% CI 0.36-5.94) between 2 groups were observed. The risks of major bleeding (RR 0.96, 95% CI 0.47-1.96) and any serious adverse event (RR 1.03, 95% CI 0.92-1.16) did not differ between 2 groups. Yet, PFO closure increased risk of atrial fibrillation (RR 4.25, 95% CI 2.10-8.60).

CONCLUSION:

PFO closure, as compared with medical therapy, was associated with decreased risk of recurrent stroke and increased risk of atrial fibrillation in cryptogenic stroke patients with PFO.

• Authors: Yingxu Ma, Dongping Li, Fan Bai, Fen Qin, Jiayi Li, Yixi Li, Na Liu, Hui Xie, Shenghua Zhou, Qiming Liu
• Journal: Medicine (Medicine (Baltimore)) Vol. 97 Issue 34 Pg. e11965 (Aug 2018) ISSN: 1536-5964 [Electronic] United States
• PMID: 30142823 (Publication Type: Journal Article, Meta-Analysis, Review)

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors

Topics

• Adult
• Anticoagulants (therapeutic use)
• Female
• Foramen Ovale, Patent (complications, therapy)
• Humans
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Randomized Controlled Trials as Topic
• Secondary Prevention (methods)
• Septal Occluder Device (statistics & numerical data)
• Stroke (etiology, prevention & control)
• Treatment Outcome