Page 27 - Journal of Structural Heart Disease Volume 4, Issue 5

Original Scientific Article
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:222-227
DOI: https://doi.org/10.12945/j.jshd.2018.047.17
Received: November 29, 2017 Accepted: December 30, 2017 Published online: October 2018
Patent Foramen Ovale Closure for Recurrent Stroke Prevention: A Network Meta-Analysis of Randomized Controlled Trials
George S. Mina, MD,1*, Demiana Soliman, MD2, Kalgi Modi, MD1
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
Abstract
Background: Patent foramen ovale (PFO) has been shown to be associated with recurrent strokes. Ran- domized 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 me- ta-analysis to evaluate three different treatment strat- egies for stroke prevention, namely, PFO closure, anti- platelet therapy and oral anticoagulation.
Methods: We searched PUBMED and Cochrane data- base for RCTs comparing PFO closure to medical ther- apy in patients with PFO and cryptogenic stroke. Three different strategies were evaluated; PFO closure, an- tiplatelet therapy alone and oral anticoagulation. A Bayesian network meta-analysis was performed to cal- culate 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 pa- tients. There was significant reduction of recurrent strokes with PFO closure when compared to antiplate- let therapy alone (OR 0.29, CrI 0.07-0.84). On the other hand, there were no statistically significant differenc- es between PFO closure and oral anticoagulation (OR 0.52, CrI 0.1-1.92) or between anticoagulation and an- tiplatelet therapy (OR 0.55, CrI 0.13-2.14).
Conclusion: In patients with PFO and cryptogenic
stroke, transcatheter PFO closure is associated with significant reduction in recurrent strokes when com- pared to antiplatelet therapy alone. This benefit was not statistically significant when PFO closure was com- pared with the use of oral anticoagulation.
Copyright © 2018 Science International Corp.
Key Words
Patent foramen ovale • Stroke • Network meta-analysis
Introduction
The presence of patent foramen ovale (PFO) has been shown to be associated with increased inci- dence of stroke. [1–3] Therefore, PFO closure has the potential of prevention of recurrent stroke events in patients with PFO and cryptogenic stroke. Random- ized controlled trials (RCTs) that evaluated the ben- efit of transcatheter PFO closure in recurrent stroke prevention showed inconsistent results. [4–9]. One of the differences between those trials is that oral an- ticoagulation was permitted in the medical therapy arm in some of the trials, [4, 6, 9] which could have contributed to the discrepancy in the results. Hence, in the current study we aimed by performing network meta-analysis to compare three different strategies for recurrent stroke prevention, namely, PFO closure, antiplatelet therapy alone and oral anticoagulation.
* Corresponding Author:
George S. Mina, MD
Department of Cardiology
Louisiana State University Health Sciences Center Shreveport 1501 Kings Hwy, Shreveport, LA 71103, USA
Tel.: +1 318 675 5941; Fax: +1 318 626 3753; E-Mail: gmina@lsuhsc.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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