Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and meta-analysis of randomized trials
| Autor: | Pengfei Yan, Xuan Niu, Zhao-hui Zhang, Zhen-tao Zhang, Shu-lan Huang, Guang Ou-Yang |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Foramen Ovale Patent 030204 cardiovascular system & hematology Cochrane Library law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Fibrinolytic Agents law Internal medicine Clinical endpoint Secondary Prevention Medicine Humans Adverse effect Stroke Randomized Controlled Trials as Topic business.industry Atrial fibrillation Foramen ovale (skull) medicine.disease medicine.anatomical_structure Neurology Patent foramen ovale Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurology. 265(6) |
| ISSN: | 1432-1459 |
| Popis: | This systematic review and meta-analysis was performed to investigate the efficacy and safety of transcatheter device closure (TDC) plus anti-thrombotic drugs over medical management alone for patients with cryptogenic stroke and patent foramen oval. PubMed, Embase and Cochrane Library database were searched for randomized controlled clinical trials (RCTs). The primary endpoint is the composite of stroke and transient ischemic attack. The secondary endpoints are all-cause mortality, total serious adverse events, atrial fibrillation and bleeding. Five RCTs with a total of 3440 participants were included. TDC significantly decreased the risk of primary endpoint when compared to medical therapy alone (RR 0.54, 95% CI 0.43–0.69). Further subgroup analyses showed that patients with male gender and with substantial shunt size of foramen ovale significantly benefited from TDC as compared to those with female gender and with no substantial shunt size of foramen oval separately. Moreover, TDC was superior to medical therapy with anti-platelet drug alone (not with anti-coagulation). On the other hand, the incidence of atrial fibrillation was higher in TDC group (RR 4.49, 95% CI 2.02–9.97), with the risk of other adverse events equivalent between the two groups. TDC plus anti-thrombotic drugs is superior than medical therapy alone for secondary prevention of stroke, especially for those with male gender and with substantial shunt size of foramen ovale. Though it may increase the risk of postoperative atrial fibrillation, it would not bring higher risk of all-cause mortality, total adverse events and bleeding. |
| Databáze: | OpenAIRE |
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