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

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Abstract

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, I2 = 50%). The association between risk of TIA only (OR: 1.36, 95% CI: 0.77–2.41, I2 = 0%) and stroke only (OR: 1.09, 95% CI: 0.54–2.21, I2 = 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.

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Abbreviations

CVD Risk Factors:

Cardiovascular Disease Risk Factors

PFO:

Patent Foramen Ovale

Total ACE:

Total Acute Cerebrovascular Events

TIA:

Transient Ischaemic Attack

DM:

Diabetes Mellitus

HTN:

Hypertension

HLD:

Hyperlipidaemia

Smoking:

Current smokers only

NA:

Not Applicable/ Available

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Author notes

  1. Benjamin YQ Tan is the senior author.

Authors and Affiliations

  1. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Xue Yang Lim, Nicholas LX Gao, Wynne Yu Lee, Jia Hui Neo, Alethea HE Tan, Ching-Hui Sia, Vijay K Sharma, Leonard LL Yeo, Yinghao Lim & Benjamin YQ Tan

  2. Department of Cardiology, National University Heart Centre, Singapore, Singapore

    Ching-Hui Sia & Yinghao Lim

  3. Division of Hematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore

    Chee Yen Lin

  4. Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Vijay K Sharma, Leonard LL Yeo, Jamie Sin Ying Ho & Benjamin YQ Tan

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  1. Xue Yang Lim
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Correspondence to Jamie Sin Ying Ho.

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Lim, X.Y., Gao, N.L., Lee, W.Y. et al. Patent foramen ovale closure in ischemic stroke patients with and without thrombophilia: a systematic review and meta-analyses. J Thromb Thrombolysis (2024). https://doi.org/10.1007/s11239-024-02990-3

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