title: Secondary prevention after cryptogenic cerebrovascular events in patients with patent foramen ovale.
abstract: BACKGROUND
  Patients with patent foramen ovale and cryptogenic stroke are at risk of recurrence, but there are few data on strategies to prevent this.
  
  
  METHODS
  We studied 280 consecutive patients with cryptogenic cerebrovascular events and a patent foramen ovale examined by multiplane transesophageal echocardiography. Patients received platelet inhibitors (n = 66) or anticoagulation (n = 47) or underwent device closure (n = 167). During the mean follow-up of 2.6 years, we compared the frequency of recurrent events, death and severe treatment complications.
  
  
  RESULTS
  A total of 33 (12%) patients had a recurrent cerebrovascular event. The annual recurrence rates were 13% in patients treated with platelet inhibitors, 5.6% in those on oral anticoagulation, and 0.6% in those after device closure. Independent predictors of recurrent cerebrovascular events were a patent foramen ovale larger than 4 mm (hazard ratio 3.8, 95% CI 1.2-11.2; p = 0.017) or previous strokes (hazard ratio 4.3, 95% CI 2.0-9.2; p < 0.001). Interventional closure of the patent foramen ovale decreased the risk of a recurrent event compared with oral anticoagulation (hazard ratio 0.06, 95% CI 0.12-0.29; p < 0.001), whereas antiplatelet therapy showed a trend to an increased risk (hazard ratio 2.3; 95% CI 0.9-5.5; p = 0.055). Major side effects occurred in 7 anticoagulated patients and in 13 patients after device closure. There were two non-vascular deaths and one fatal hemorrhagic stroke.
  
  
  CONCLUSIONS
  Patients with a large patent foramen ovale and a cryptogenic cerebrovascular event had a substantial risk of recurrence even with medical treatment. Risk of recurrence was lower after device closure of the patent foramen ovale.
authors.affiliation: Medical Department II, LKH Graz-West, Graz, Austria. herwig.schuchlenz@lkh-grazwest.at
authors.forename: Herwig Walter
authors.initials: HW
authors.lastname: Schuchlenz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weihs
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
authors.forename: Anita
authors.initials: A
authors.lastname: Lechner
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019919:Prosthesis Implantation; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors