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Patent Foramen Ovale and Risk for Recurrent Stroke

PFO does not significantly raise risk for recurrent cerebral ischemic events.

Among patients with cryptogenic stroke, whether the presence of a patent foramen ovale (PFO) elevates risk for recurrent cerebral ischemia is unclear. In a meta-analysis, researchers examined this question.

In four controlled observational studies involving 1081 medically treated patients with previous cryptogenic stroke or transient ischemic attack (TIA), patients with and without PFOs were compared. During mean follow-ups of 31 to 42 months, risk for recurrent stroke or TIA was not significantly elevated in patients who had PFOs compared with those who did not (relative risk, 1.1). In addition, risk for stroke alone was similar in the two groups (RR, 0.8 for PFO patients).

The researchers also calculated the absolute rate of recurrent cerebral ischemic events in patients with PFO, using both these 4 controlled studies and 11 noncontrolled observational studies of patients with cryptogenic stroke or TIA. In the 15 studies, the pooled rate for recurrent cerebral ischemic events in patients with PFOs was 4.0 events per 100 patient-years; the rate for stroke alone was 1.6 events per 100 patient-years.

Comment: This analysis suggests that PFO does not significantly contribute to risk for recurrent cerebral ischemic events and that absolute risk for recurrent events in patients with PFOs is fairly low. One implication is that closure of PFOs to prevent recurrent stroke should be resisted until clinical trials confirm the efficacy of that procedure. Finally, some (but not all) studies have suggested that stroke risk is higher when PFO is accompanied by an atrial septal aneurysm.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 6, 2009
с уважением, Артемий Охотин

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