Patent foramen ovale, role of antiplatelet therapy alone or anticoagulant therapy alone versus device closure for cryptogenic stroke: A review of literature and current recommendations.

Patent foramen ovale, role of antiplatelet therapy alone or anticoagulant therapy alone versus device closure for cryptogenic stroke: A review of literature and current recommendations. Cardiovasc Hematol Agents Med Chem. 2020 Feb 02;: Authors: Nagarajarao HS, Ojha CP, Kedar A, Mukherjee D Abstract Cryptogenic stroke and its relation to the Patent foramen ovale (PFO) is a long debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between right and left atria in approximately 25-27% of adults [1, 2]. In this review we examine the clinical relevance of the PFO with analysis of latest trials evaluating catheter-based closure of PFO's for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients' with PFO who do not qualify for closure per current guidelines. PMID: 32013839 [PubMed - as supplied by publisher]
Source: Cardiovascular and Hematological Agents in Medicinal Chemistry - Category: Cardiology Tags: Cardiovasc Hematol Agents Med Chem Source Type: research

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AbstractHigh-risk PE can be complicated by the presence of a patent foramen ovale (PFO), which can lead to paradoxical systemic embolization, including cerebral embolism ultimately leading to acute ischemic stroke (AIS). Acute management is challenging given the competing benefits and risks of systemic thrombolysis. Herein, we aim to provide a review of clinical presentations, diagnostic findings, and treatment and outcome from the available literature, with the hopes of providing insight into treatment options. We followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (P...
Source: Emergency Radiology - Category: Emergency Medicine Source Type: research
IN THIS issue of the Journal of Cardiothoracic and Vascular Anesthesia, Villablanca et al. evaluated whether the presence and diagnosis of a patent foramen ovale (PFO) or atrial septal defect (ASD) preoperatively was associated with an increase in perioperative stroke for patients undergoing noncardiac surgery.1 The authors used “big data” to describe the largest study to date of 19,659,191 hospitalizations retrieved from the Healthcare Cost and Utilization Project's National Readmission Database.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
Authors: Ntaios G, Tzikas A, Vavouranakis E, Nikas D, Katsimagklis G, Koroboki E, Manolis AS, Milionis H, Papadopoulos K, Sideris S, Spengos K, Toutouzas K, Tziakas D, Vassilopoulou S, Kanakakis I, Vemmos K, Tsioufis K Abstract Patent foramen ovale (PFO) is a frequent echocardiographic finding and can be found in approximately 15-25% of the general population1 (Figure 1). The incidence of PFO is 2- to 3-fold higher in patients with stroke of undetermined etiology compared to the general population, a finding that implies a causative role of PFO in patients with stroke of undetermined etiology 2,3. In this context, ...
Source: Hellenic Journal of Cardiology - Category: Cardiology Tags: Hellenic J Cardiol Source Type: research
Conclusions: Stroke management is based on evaluation of individual patient-risk factors. Evaluation and treatment is ideally directed by a vascular neurologist to ensure optimal secondary prevention, especially in cases where an underlying etiology is not identified on initial workup.
Source: Journal of Neuro-Ophthalmology - Category: Opthalmology Tags: Disease of the Year: Cerebrovascular Disorders Source Type: research
To evaluate whether a preoperative diagnosis of atrial septal defect (ASD) or patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery and their outcomes.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Conclusions: Stroke management is based on evaluation of individual patient-risk factors. Evaluation and treatment is ideally directed by a vascular neurologist to ensure optimal secondary prevention, especially in cases where an underlying etiology is not identified on initial workup.
Source: Journal of Neuro-Ophthalmology - Category: Opthalmology Tags: Disease of the Year: Cerebrovascular Disorders Source Type: research
Conditions:   Cryptogenic Stroke;   High Risk Patent Foramen Ovale Intervention:   Procedure: Percutaneous device closure Sponsors:   Asan Medical Center;   Medtronic Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Authors: Khan R Abstract Introduction: There has been considerable study assessing the treatment of cryptogenic stroke (CS) recently. This review examines the role of patent foramen ovale (PFO) closure in CS, while also discussing the evidence for alternative medical therapies in disease treatment.Areas Covered: PFO closure for treatment of CS has been assessed in 6 randomized controlled trials (RCTs). This review summarizes the background, results and limitations of these trials. Methodological and treatment-related differences in RCTs provide potential explanations for the discordance in outcomes observed between...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Cryptogenic Stroke/ESUS International Working Group defined embolic stroke of undetermined source (ESUS) as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation [1]. They presumed that as emboli are more likely to be thrombi, recurrence may be better prevented by anticoagulation rather than antiplatelet agents. Randomized trials with directly acting oral anticoagulants were suggested to test this hypothesis. But two randomised trials testing this aspect, NAVIGATE ESUS (Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
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