The Best Option for Preventing Cryptogenic Embolism
(Ivanhoe Newswire) -- Past studies have shown an association of cryptogenic stroke and embolism with patent foramen ovale (PFO). However, the question of how to prevent it in patients remains unanswered. Now, recent research is investigating whether percutaneous closure or antithrombotic medications are superior.
Antithrombotic treatment can be done with warfarin or antiplatelet agents. Surgical or endovascular closure is the other option.
Starting in February of 2000, researchers performed a multicenter, superiority trial in 29 centers in Australia, Brazil, Canada, and Europe, that included 414 patients. Patients with PFO and ischemic stroke, transient ischemic attack (TIA), or a peripheral thromboembolic event were randomly assigned to partake in closure of the PFO with the Amplatzer PFO Occluder or received medical therapy.
The primary endpoints were death, nonfatal stroke, TIA, or peripheral embolism.
The mean duration of follow-up was 4.1 years in the closure group and four years in the medical-therapy group. The primary end point happened in seven out of the 204 patients in the closure group and 11 of the 210 patients in the medical-therapy group.
Nonfatal stroke occurred in one patient in the closure group and five patients in the medical-therapy group. TIA occurred in five patients in the closure group and seven patients in the medical-therapy group.
Researcher’s results showed that the closure of a PFO for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy.
SOURCE: New England Journal of Medicine, March 2013