Comparison of the antithrombotic strategy implemented to prevent early recurrence before closure of patent foramen ovale

BackgroundBenefits of percutaneous patent foramen ovale (PFO) closure is demonstrated in PFO-associated stroke for secondary prevention, compared with medical treatment alone. Unfortunately, stroke recurrence can occur before PFO closure. However, no study has focused on the prevention of early cerebral ischemic recurrences that can occur before closure. The aim of our study was to compare the antithrombotic strategy implemented to prevent early cerebral ischemic recurrences before PFO closure. MethodThis is a retrospective, single-center cohort study of adult patients with ischemic stroke who underwent PFO closure at Cardiology Hospital in Lyon between January 3, 2020, and November 22, 2023. The primary outcome was the occurrence of an ischemic recurrence, stroke or transient ischemic attack (TIA), before closure. Major bleeding represented the safety endpoint. ResultsIn this retrospective cohort of 492 patients with an indication for PFO closure performed within one year following an ischemic stroke, 384 (78%) were under antiplatelet therapy (APT) and 108 (22%) under anticoagulant treatment (ACT). There were 15 early cerebral ischemic recurrences. All of these occurred under APT. Complete separation of the data prevented us to conclude with a logistic regression but suggested a significant link between APT and ischemic recurrence. No serious bleeding complication occurred. ConclusionOur retrospective cohort of PFO-related stroke patients suggests that early ischemic recurrences are more frequent with APT than with ACT, with no increase in hemorrhagic risk. The superiority of an antithrombotic strategy in this early time window (before PFO-closure) had not been previously studied, and our results need a randomized trial for confirmation.