Author + information
- Yonatan Buber,
- David Orion,
- Sharon Borik,
- Ori Varuri and
- Victor Guetta
Background: Cryptogenic stroke is a dreadful outcome for patients with patent foramen ovales (PFO's). Higher incidences of cryptogenic strokes are reported in patients with PFO's and inherited thrombophilias (ITs) such as the Prothrombin and Factor V Leiden mutations. Since carriers of IT's are usually maintained on anticoagulant/antiaggregant therapy, the potential benefit of PFO closure in this population is unclear. We therefore sought to evaluate the incidence of strokes or transient ischemic attacks (TIA's) among patients with clinically significant IT's who were also found to have a PFO.
Methods: Demographic and clinical data on 511 consecutive patients with confirmed PFO's evaluated at a coagulation clinic for IT's was retrospectively collected. For patients with a confirmed IT, adherence to anticoagulant/antiaggregant therapy was recorded at the time of the stroke or, in the absence of stroke, at the time of clinic visits. The outcome of the study was defined as stroke or TIA during follow-up.
Results: Of the 511 patients, 137 were diagnosed with IT's (31%, antiphospholipid syndrome, 23%, factor 5 Leiden mutation, 15%, protein S deficiency, 13%, MTHFR mutation, 7%, protein C deficiency, 7%, Prothrombin mutation, 4%, essential thrombocytosis). 76% of the patients were maintained on vitamin K antagonists and the rest were taking antiaggregants. PFO device closure was undertaken in 85 patients (62%). At a mean follow up of 51+8 months, 23 patients (17%, 95% confidence interval, 9.3%-22%) experienced an event, mainly in the form of a stroke (n=20, 87%). Multivariate analysis showed that lack of PFO closure was associated with a 5-fold increase in the risk for recurrent events (p = 0.02). This effect were maintained regardless of the type of IT and anticoagulation/antiaggregant treatment.
Conclusions: In this analysis, PFO device closure for patients with confirmed IT's was associated with a significantly lower risk of stroke occurrence regardless of anticoagulant or antiaggregant therapies.
Saturday, March 18, 2017, 8:25 a.m.-8:35 a.m.
Session Title: Highlighted Original Research: Interventional Cardiology and the Year in Review
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 903-06
- 2017 American College of Cardiology Foundation