Original Scientific Articles
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:222-227
Patent Foramen Ovale Closure for Recurrent Stroke Prevention: A Network Meta-Analysis of Randomized Controlled Trials
1 Department of Cardiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
2 Volunteer Researcher, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
Background: Patent foramen ovale (PFO) has been shown to be associated with recurrent strokes. Randomized controlled trials (RCTs) evaluating the benefit of transcatheter closure of PFO over medical therapy in patients with cryptogenic stroke showed inconsistent results.
Objectives: We aimed by performing network meta-analysis to evaluate three different treatment strategies for stroke prevention, namely, PFO closure, antiplatelet therapy, and oral anticoagulation.
Methods: We searched PUBMED and Cochrane database for RCTs comparing PFO closure to medical therapy in patients with PFO and cryptogenic stroke. Three different strategies were evaluated; PFO closure, antiplatelet therapy alone and oral anticoagulation. A Bayesian network meta-analysis was performed to calculate odds ratios (OR) and 95% credible intervals (CrI). The outcome of this study was recurrent stroke events at the longest follow-up period reported.
Results: We included 4 RCTs with a total of 2821 patients. There was a significant reduction of recurrent strokes with PFO closure when compared to antiplatelet therapy alone (OR 0.29, CrI 0.07-0.84). On the other hand, there were no statistically significant differences between PFO closure and oral anticoagulation (OR 0.52, CrI 0.1-1.92) or between anticoagulation and antiplatelet therapy (OR 0.55, CrI 0.13-2.14). Conclusion: In patients with PFO and cryptogenic stroke, transcatheter PFO closure is associated with a significant reduction in recurrent strokes when compared to antiplatelet therapy alone. This benefit was not statistically significant when PFO closure was compared with the use of oral anticoagulation.
Cite this article as: Mina GS, Soliman D, Modi K. Patent Foramen Ovale Closure for Recurrent Stroke Prevention: A Network Meta-Analysis of Randomized Controlled Trials. Structural Heart Disease 2018;4(5):222-227. DOI: 10.12945/j.jshd.2018.047.17
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