What are the guidelines on secondary stroke prevention in patients with patent foramen ovale (PFO)?

Updated: Jan 10, 2016
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Stroke patients with patent foramen ovale (PFO) do not have a significantly higher risk of recurrent stroke or death compared with those without a PFO, and given the known increased risk of bleeding complications with anticoagulation and the lack of data to demonstrate a benefit in terms of reduction of recurrent ischemic cardiovascular events, ACCP guidelines do not recommend anticoagulation for this population. [11]

However, AHA/ASA guidelines give a class I recommendation for anticoagulation in patients with both a PFO and a venous source of embolism. When anticoagulation is contraindicated, an inferior vena cava filter is an option (class IIa). In patients with PFO who are not undergoing anticoagulation therapy, antiplatelet therapy is recommended.(Class I) [7]

PFO closure is an alternative to antithrombotic therapy but lacks clinical evidence of effectiveness. Consequently, the ACCP suggests that patients with stroke and PFO be treated with antiplatelet therapy following the recommendations for patients with noncardioembolic stroke. [11]

The AHA/ASA recommends against the closing of a PFO in patients who do not have deep vein thrombosis (DVT). For those patient with DVT, closure by transcatheter device can be considered, depending on the risk of recurrent DVT. Like the ACCP, AHA/ASA guidelines recommend antiplatelet therapy. [7]

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