Patent Foramen Ovale Closure Reduces Stroke Risk in Patients With Inherited Thrombophilias

Patients with inherited thrombophilias who did not undergo patent foramen ovale closure faced a significantly increased risk of stroke.

Patients with inherited thrombophilias who undergo patent foramen ovale (PFO) device closure face a significantly reduced risk of stroke occurrence regardless of adherence to anticoagulant or antiaggregant therapies, according to a study presented at the American College of Cardiology Annual Scientific Sessions, March 17-19, 2017 in Washington, D.C.

The risk of cryptogenic stroke is elevated in patients with PFO and confirmed inherited thrombophilias, including prothrombin and Factor V Leiden mutations. While patients with these mutations are typically on anticoagulant or antiaggregant therapy to manage stroke risk, it is not known whether PFO closure holds additional benefit.

Investigators led by Yonatan Buber, MD, of Nationwide Children’s Hospital in Columbus, Ohio collected demographic and clinical data from 511 patients with PFOs who were evaluated for inherited thrombophilias. Status of anticoagulant/antiaggregant therapy was recorded at the time of stroke or clinic visits in patients without stroke.

Ultimately, 137 patients were diagnosed with confirmed inherited thromobophilia (31% antiphospholipid syndrome; 23% Factor V Leiden mutation; 15% protein S deficiency; 13% MTHFR mutation; 7% protein C deficiency; 7% prothrombin mutation; and 4% essential thrombocytosis), 76% of whom were taking vitamin K antagonists. Of the patients, 62% (n=85) underwent PFO closure; in that group, 17% (n=23) experienced an event (95% CI, 9.3%-22%) — typically a stroke (n=20) — within a mean follow-up period of 51±8 months. After multivariate analysis, the investigators found that patients who did not undergo PFO closure had 5 times the risk of experiencing recurrent events (P =.02), regardless of inherited thrombophilia subtype or anticoagulant/antiaggregant therapy.

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Buber Y, Orion D, Borik S, Varuri O, Guetta V. Percutaneous closure of patent foramen ovale is associated with lower incidence of cryptogenic strokes among patients with inherited thrombophilias treated with anticoagulant or antiaggregant therapy. Presented at: 2017 American College of Cardiology Scientific Sessions. March 17-19, 2017; Washington, DC. Abstract 903-06.