Patent foramen ovale closure in ischemic stroke patients with and without thrombophilia: a systematic review and meta-analyses.

Autor: Lim XY; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Gao NL; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Lee WY; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Neo JH; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Tan AH; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Sia CH; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Department of Cardiology, National University Heart Centre, Singapore, Singapore., Sharma VK; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore., Yeo LL; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore., Lim Y; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Department of Cardiology, National University Heart Centre, Singapore, Singapore., Lin CY; Division of Hematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore., Ho JSY; Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. sinyingh@gmail.com., Tan BY; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Jazyk: angličtina
Zdroj: Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2024 Aug; Vol. 57 (6), pp. 947-958. Date of Electronic Publication: 2024 May 18.
DOI: 10.1007/s11239-024-02990-3
Abstrakt: Ischemic stroke patients with thrombophilia and patient foramen ovale (PFO) may have an increased risk of recurrent stroke and transient ischemic attack (TIA), and may benefit from PFO closure. However, screening for thrombophilia is not routinely performed and the impact of thrombophilia on prognosis after PFO closure is uncertain. We aim to compare the risk of recurrent stroke and TIA after PFO closure in patients with thrombophilia versus those without. We performed a systematic review and meta-analyses of the literature, with a comprehensive literature search performed on 12 January 2023. Studies comparing the outcomes of patients with and without thrombophilia after PFO closure were included. The primary outcome evaluated was a recurrence of acute cerebrovascular event (ACE), a composite of recurrent ischemic stroke and recurrent TIA. The secondary outcomes included recurrent ischemic stroke only or TIA only. A total of 8 cohort studies were included, with a total of 3514 patients. There was an increased risk of stroke/TIA in patients with thrombophilia compared to those without thrombophilia after PFO (OR: 1.42, 95% CI: 1.01-1.99, I 2  = 50%). The association between risk of TIA only (OR: 1.36, 95% CI: 0.77-2.41, I 2  = 0%) and stroke only (OR: 1.09, 95% CI: 0.54-2.21, I 2  = 0%) with thrombophilia did not reach statistical significance. There is an increased risk of recurrent cerebral ischemia event in patients with thrombophilia compared to those without thrombophilia after PFO closure. Future large prospective studies are necessary to characterise the risk and benefits of PFO closure, as well as the appropriate medical treatment to reduce the risk of recurrent stroke and TIA in this high-risk population.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: