Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis
| Autor: | Elisa Maria Fiorelli, Viviana Bozzano, Eleonora Tobaldini, Mattia Bonzi, Monica Solbiati, Delia Gagliardi, Giacomo P. Comi, Nicola Montano, Elio Scarpini, Tiziana Carandini |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Foramen Ovale Patent 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Risk Factors Internal medicine Internal Medicine medicine Secondary Prevention Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Stroke Intention-to-treat analysis business.industry Anticoagulant medicine.disease Treatment Outcome Embolism Relative risk Emergency Medicine Cardiology Patent foramen ovale business |
| Zdroj: | Internal and emergency medicine. 13(8) |
| ISSN: | 1970-9366 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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