Patent foramen ovale medical therapy
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Patent Foramen Ovale Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
There is a lack of consensus on the medical therapy for patent foramen ovale. Asymptomatic patent foramen ovale doesn't warrant any treatment. The incidence of recurrent stroke in patients with index episode of cryptogenic stroke and treated with aspirin or warfarin has been found similar in presence or absence of a patent foramen ovale. However, an increased risk of subsequent stroke in medically treated patients has been seen in patent foramen ovale associated with atrial septal aneurysm. There are lack of studies to compare the efficacy of aspirin and warfarin, however aspirin safety profile has been found to be better than warfarin.
Internatioanl guidelines for prevention of recurrent cerebral embolism in patent foramen ovale
American Academy of Neurology Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT)[1]
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Practice Recommendations 1) For patients who have had a cryptogenic stroke and have a patent foramen ovale (PFO), the evidence indicates that the risk of subsequent stroke or death is no different from other cryptogenic stroke patients without PFO when treated medically with antiplatelet agents or anticoagulants. Therefore, in persons with a cryptogenic stroke receiving such therapy, neurologists should communicate to patients and their families that presence of PFO does not confer an increased risk for subsequent stroke compared to other cryptogenic stroke patients without atrial abnormalities (Level A). However, it is possible that the combination of PFO and atrial septal aneurysm (ASA) confers an increased risk of subsequent stroke in medically treated patients who are less than 55 years of age. Therefore, in younger stroke patients, studies that can identify PFO or atrial septal aneurysm (ASA) may be considered for prognostic purposes (Level C). 2) Among patients with a cryptogenic stroke and atrial septal abnormalities, there is insufficient evidence to determine the superiority of aspirin or warfarin for prevention of recurrent stroke or death (Level U), but the risks of minor bleeding are possibly greater with warfarin (Level C) |
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Rating of Recommendations
A = Established as effective, ineffective, or harmful for the given condition in the specified population.
B = Probably effective, ineffective, or harmful for the given condition in the specified population.
C = Possibly effective, ineffective, or harmful for the given condition in the specified population.
U = Data inadequate or conflicting. Given current knowledge, treatment (test, predictor) is unproven.
American Academy of Chest Physicians Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT) [2]
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Findings No clear advantage of warfarin over antiplatelets Recommendations Antiplatelet treatment recommended. |
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American Heart Association/American Stroke Association guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT)[3]
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1 Antiplatelet therapy reasonable 2 Warfarin reasonable for high-risk patients with other indications such as hypercoagulable state or venous thrombosis |
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European Stroke Organisation guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT)[4]
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1 Patients with cardioembolic stroke unrelated to atrial fibrillation should receive warfarin if the risk of recurrence is high. |
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References
- ↑ Messé SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G; et al. (2004). "Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 62 (7): 1042–50. PMID 15078999.
- ↑ Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P (2004). "Antithrombotic and thrombolytic therapy for ischemic stroke: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 Suppl): 483S–512S. doi:10.1378/chest.126.3_suppl.483S. PMID 15383482.
- ↑ Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC; et al. (2011). "Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association". Stroke. 42 (1): 227–76. doi:10.1161/STR.0b013e3181f7d043. PMID 20966421.
- ↑ European Stroke Organisation (ESO) Executive Committee. ESO Writing Committee (2008). "Guidelines for management of ischaemic stroke and transient ischaemic attack 2008". Cerebrovasc Dis. 25 (5): 457–507. doi:10.1159/000131083. PMID 18477843.