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01-12-2018 | CE - SYSTEMATIC REVIEW

Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis

Authors: Elisa Maria Fiorelli, Tiziana Carandini, Delia Gagliardi, Viviana Bozzano, Mattia Bonzi, Eleonora Tobaldini, Giacomo Pietro Comi, Elio Angelo Scarpini, Nicola Montano, Monica Solbiati

Published in: Internal and Emergency Medicine | Issue 8/2018

Abstract

The aim of our study is to compare patent foramen ovale (PFO) closure versus medical treatment and antiplatelet versus anticoagulant therapy in patients with cryptogenic stroke (CS) and PFO. We conducted a systematic review and meta-analysis with trial sequential analysis (TSA) of randomized trials. Primary outcomes are stroke or transient ischemic attack (TIA) and all-cause mortality. Secondary outcomes are peripheral embolism, bleeding, serious adverse events, myocardial infarction and atrial dysrhythmias. We performed an intention to treat meta-analysis with a random-effects model. We include six trials (3677 patients, mean age 47.3 years, 55.8% men). PFO closure is associated with a lower recurrence of stroke or TIA at a mean follow-up of 3.88 years compared to medical therapy [risk ratio (RR) 0.55, 95% CI 0.38–0.81; I² = 40%]. The TSA confirms this result. No difference is found in mortality (RR 0.74, 95% CI 0.35–1.60; I² = 0%), while PFO closure is associated with a higher incidence of atrial dysrhythmias (RR 4.55, 95% CI 2.16–9.60; I² = 25%). The rate of the other outcomes is not different among the two groups. The comparison between anticoagulant and antiplatelet therapy shows no difference in terms of stroke recurrence, mortality and bleeding. There is conclusive evidence that PFO closure reduces the recurrence of stroke or TIA in patients younger than 60 years of age with CS. More data are warranted to assess the consequences of the increase in atrial dysrhythmias and the advantage of PFO closure over anticoagulants.

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Title: Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis
Authors: Elisa Maria Fiorelli
Tiziana Carandini
Delia Gagliardi
Viviana Bozzano
Mattia Bonzi
Eleonora Tobaldini
Giacomo Pietro Comi
Elio Angelo Scarpini
Nicola Montano
Monica Solbiati
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Internal and Emergency Medicine / Issue 8/2018
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-018-1909-8

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