Evolving Approaches to Antithrombotics in Stroke Prevention and Treatment

Vijayakumar Javalkar, MD, MCh; Okkes Kuybu, MD; Abdallah Amireh, MD; Roger E. Kelley, MD


South Med J. 2020;113(11):585-592. 

In This Article

Patent Foramen Ovale (PFO)

A systematic review and meta-analysis of RCTs reported that in patients younger than 60 years, PFO closure plus medical antithrombotic therapy (primarily antiplatelet) was beneficial in reducing recurrent ischemic stroke when compared with long-term antithrombotic (antiplatelet or anticoagulant) therapy alone.[26] Two RCTs compared anticoagulants against antiplatelet therapy in a subgroup of patients with PFO and cryptogenic stroke and found no significant efficacy differences.[27,28] A subgroup analysis of the NAVIGATE ESUS trial,[29] which included a random-effects meta-analysis, in patients with PFO revealed up to a 50% reduction of recurrent stroke with rivaroxaban over aspirin; however, the methodology was viewed as imprecise.