scholarly journals Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

2018 ◽  
Vol 17 (12) ◽  
pp. 1053-1060 ◽  
Author(s):  
Scott E Kasner ◽  
Balakumar Swaminathan ◽  
Pablo Lavados ◽  
Mukul Sharma ◽  
Keith Muir ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Patent Foramen Ovale ◽  
Embolic Stroke ◽  
Foramen Ovale

Abstract WP264: Frequency of Hypercoagulability in Patients With Embolic Stroke of Undetermined Source and Patent Foramen Ovale

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Liu ◽  
Srikant Rangaraju ◽  
Alexander Duncan ◽  
Samir Belagaje ◽  
Trina Belair ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Embolic Stroke ◽  
Composite Outcome ◽  
Foramen Ovale ◽  
Primary Mechanism ◽  
Detailed Evaluation ◽  
D Dimer

Introduction: Patent foramen ovale (PFO) is more commonly found in patients with cryptogenic stroke and paradoxical embolism is commonly assumed to be the primary mechanism. Our objective was to determine the frequency of hypercoagulability in cryptogenic stroke patients and PFO. Methods: Consecutive patients with embolic stroke of undetermined source (ESUS) seen at the Emory Clinic from January 1, 2017 to June 30, 2019 who underwent echocardiogram with bubble study and markers of coagulation and hemostatic activation (MOCHA) testing (serum d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) were included; abnormal MOCHA was defined as ≥ 2 elevated markers. Venous thromboembolism, malignancy, other defined hypercoagulable state, and the composite outcome were assessed at routine follow-up and compared across groups based on PFO status. Results: Of 172 patients (mean age 63 ± 16 years, 60% female), 40 (23%) had a PFO. Compared to the PFO- group, the PFO+ group was younger (p=<0.001), less likely to have hypertension (p<0.001) and diabetes (p=0.011), and had a higher ROPE score (p=0.007) (Table 1). There was no difference in the frequency of abnormal MOCHA between groups and the composite outcome was less frequent in PFO+ versus PFO- patients (p=0.017). In the subgroup of patients <60 years old, there was no difference in the frequency of abnormal MOCHA and the composite outcome. Conclusion: Hypercoagulability as measured by MOCHA was not associated with the presence of PFO in ESUS patients. Based on our results, ESUS patients should undergo a detailed evaluation for alternative causes of stroke other than paradoxical embolism.

Carotid Atherosclerosis and Patent Foramen Ovale in Embolic Stroke of Undetermined Source

2021 ◽  
Vol 30 (1) ◽  
pp. 105409
Author(s):  
George Ntaios ◽  
Dimitrios Sagris ◽  
Davide Strambo ◽  
Kalliopi Perlepe ◽  
Gaia Sirimarco ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Carotid Atherosclerosis ◽  
Embolic Stroke ◽  
Foramen Ovale

Dabigatran or Aspirin After Embolic Stroke of Undetermined Source in Patients With Patent Foramen Ovale

Stroke ◽  
2021 ◽  
Author(s):  
Hans-Christoph Diener ◽  
Aurauma Chutinet ◽  
J. Donald Easton ◽  
Christopher B. Granger ◽  
Eva Kleine ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Patent Foramen Ovale ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Dabigatran Etexilate ◽  
Embolic Stroke ◽  
Thrombin Inhibitor ◽  
Foramen Ovale ◽  
Significant Difference

Background and Purpose: Patent foramen ovale (PFO) may increase the risk of embolic stroke of undetermined source (ESUS). Guidelines suggest anticoagulation may be more effective than antiplatelets in preventing stroke in patients with ESUS and PFO when interventional closure is not performed. Methods: Patients with ESUS randomized to dabigatran (150/110 mg BID) or aspirin (100 mg QD) from the RE-SPECT ESUS study (Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source) were included. The rate of recurrent stroke (primary end point) and ischemic stroke was reported for patients with and without baseline PFO. A meta-analysis comparing the effects of anticoagulant and antiplatelet therapy on ischemic stroke in patients with PFO was updated to include RE-SPECT ESUS. Results: PFO was present in 680 of 5388 (12.6%) patients with documented PFO status. The risk of recurrent stroke with dabigatran versus aspirin was similar in patients with and without PFO ( P for interaction, 0.8290). In patients with PFO, the meta-analysis found no statistically significant difference between anticoagulant and antiplatelet therapy (odds ratio, 0.70 [95% CI, 0.43–1.14]) for ischemic stroke. Conclusions: There is insufficient evidence to recommend anticoagulation over antiplatelet therapy for patients with ESUS and a PFO. More data are needed to guide antithrombotic therapy in this population. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02239120.

Abstract WP278: Markers of Coagulation and Hemostatic Activation in Embolic Stroke of Undetermined Source (ESUS) Patients With Patent Foramen Ovale

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Vera Sharashidze ◽  
Srikant Rangaraju ◽  
Priyadharshi Rathakrishnan ◽  
Alexander Duncan ◽  
Michael Hoskins ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Embolic Stroke ◽  
Foramen Ovale

scholarly journals The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: a Meta-Analysis of Randomized Controlled Trials and Observational Studies

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Quan-Quan Zhang ◽  
Jia-Jie Lu ◽  
Man-Yun Yan ◽  
Xiao-Wei Hu ◽  
Yi-Ren Qin ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Patent Foramen Ovale ◽  
Observational Studies ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Foramen Ovale ◽  
Randomized Controlled ◽  
Closure Group ◽  
Pfo Closure

Objectives. Whether patent foramen ovale (PFO) closure is effective on migraine is controversial. This article was aimed at assessing the efficacy of PFO closure on migraine based on randomized controlled trials (RCTs) and observational studies. Methods. We searched PubMed, Embase, and Cochrane databases up to October 2020 evaluating PFO closure versus control in patients with migraine, then conducted a meta-analysis of all RCTs and observational studies, respectively. The main outcomes were (1) respond rate: complete cessation of migraine; (2) reduction in the frequency of migraine attacks per month; and (3) reduction in migraine days per month. Results. Seven studies (3 RCTs and 4 observational studies), containing 887 migraine patients, were identified. (1) The respond rate of PFO closure on migraine was significantly higher than control group both in RCT subgroup and observational studies subgroup (OR 3.86, 95% CI 1.35-11.04, P = 0.01 in RCTs; OR 8.28, 95% CI 2.31-29.67, P = 0.001 in observational studies). (2) Reduction in frequency of migraine attacks was higher in PFO closure group compared with control group in the RCT subgroup analysis ( mean   difference   MD = 0.57 , 95% CI 0.23-0.90, P = 0.0009 ). (3) Reduction in migraine days was also higher in PFO closure group compared with control group in the RCT subgroup analysis ( MD = 1.33 , 95% CI 0.35-2.31, P = 0.008 ). Conclusions. PFO closure might be suitable for migraine patients, especially for migraine with aura, by cessation of migraine headaches or reducing migraine attacks and migraine days.

scholarly journals Patent Foramen Ovale Closure in Old Stroke Patients: A Subgroup Analysis of the DEFENSE-PFO Trial

2021 ◽  
Vol 23 (2) ◽  
pp. 289-292
Author(s):  
Hanim Kwon ◽  
Pil Hyung Lee ◽  
Jae-Kwan Song ◽  
Sun U. Kwon ◽  
Dong-Wha Kang ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Stroke Patients
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