Recurrence Risk in Patients with Cryptogenic Stroke, Patent Foramen Ovale, and Thrombophilia: A Systematic Review and Meta-Analysis

Thrombosis and Haemostasis
Claus V B HviidAnne-Mette Hvas

Abstract

A patent foramen ovale (PFO) is frequently associated with cryptogenic stroke in the young. Endovascular closure is superior to antithrombotic treatment in prevention of recurrence, but in the presence of a concomitant thrombophilia, the best preventive strategy is unknown. This review investigates if thrombophilia increases the risk of recurrence in patients with cryptogenic stroke and PFO and attempts to evaluate the best antithrombotic strategy after PFO closure in these patients. Medline, Embase, and Web of Science were searched until April 2018. Study quality was assessed by the National Heart, Lung and Blood Institute Quality assessment tool. Odds ratio (OR) and hazard ratio for recurrence were pooled in a random effect model stratified by secondary preventive strategy. Eleven studies were included. Inherited or acquired thrombophilia was associated with an increased risk of recurrence (OR = 2.41, 95% confidence interval [CI]: 1.44-4.06). Looking only at patients treated with PFO closure, the risk of recurrence just lost significance (OR = 2.07, 95% CI: 0.95-4.48). The antithrombotic treatment after PFO closure was heterogeneous and recurrent events occurred in patients with both inherited and acquired thrombophilia treat...Continue Reading

Citations

Jul 17, 2020·Frontiers in Neurology·Stefanos G Ioannidis, Panayiotis D Mitsias
Apr 28, 2020·Current Pharmaceutical Design·Maria DrakopoulouDimitrios Tousoulis
Dec 12, 2020·Thrombosis and Haemostasis·Yutao GuoGregory Y H Lip
Feb 1, 2021·Neurology and Therapy·Saba NaghaviIman Adibi
Jul 16, 2021·Current Opinion in Hematology·Ruben RhoadesNicholas Ruggiero

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