Thrombophilic patients who have had an ischemic stroke and have a patent foramen ovale (PFO) benefit from having the PFO closed, a new study suggests.
"To the best of our knowledge, this is the largest prospective study on recurrent events in hypercoagulable patients with PFO associated embolism," the authors, led by Kai Liu, MD, Massachusetts General Hospital, Boston, write.
The study is published in the December 14 issue of JACC: Cardiovascular Interventions.
They explain that randomized controlled trials have shown PFO closure to be superior to medical therapy in reducing recurrent stroke or transient ischemic attack (TIA) in patients with no other known cause of ischemic stroke. But these studies have excluded many potentially high-risk patients with thrombophilia (hypercoagulable state), who are at increased risk of recurrent events and are currently treated with anticoagulation.
"Thus far, there has been little beside clinical experience to guide treatment of patients with PFO stroke with thrombophilia," they note.
They estimate that the combination of a hypercoagulable state and PFO has a prevalence of 5% to 31%, and the presence of the two conditions may increase the risk for stroke.
The current study involved 591 patients with cryptogenic stroke attributed to PFO, of whom 134 patients (22.7%) were identified as having least one thrombophilia abnormality.
