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Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and meta-analysis of randomized trials

Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and... Objective This systematic review and meta-analysis was performed to investigate the efficacy and safety of transcatheter device closure (TDC) plus anti-thrombotic drugs over medical management alone for patients with cryptogenic stroke and patent foramen oval. Methods PubMed, Embase and Cochrane Library database were searched for randomized controlled clinical trials (RCTs). The primary endpoint is the composite of stroke and transient ischemic attack. The secondary endpoints are all-cause mor- tality, total serious adverse events, atrial fibrillation and bleeding. Results Five RCTs with a total of 3440 participants were included. TDC significantly decreased the risk of primary endpoint when compared to medical therapy alone (RR 0.54, 95% CI 0.43–0.69). Further subgroup analyses showed that patients with male gender and with substantial shunt size of foramen ovale significantly benefited from TDC as compared to those with female gender and with no substantial shunt size of foramen oval separately. Moreover, TDC was superior to medical therapy with anti-platelet drug alone (not with anti-coagulation). On the other hand, the incidence of atrial fibrillation was higher in TDC group (RR 4.49, 95% CI 2.02–9.97), with the risk of other adverse events equivalent between the two groups. Conclusions TDC plus anti-thrombotic drugs is superior than medical http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Neurology Springer Journals

Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and meta-analysis of randomized trials

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature
Subject
Medicine & Public Health; Neurology; Neurosciences; Neuroradiology
ISSN
0340-5354
eISSN
1432-1459
DOI
10.1007/s00415-018-8766-2
pmid
29383514
Publisher site
See Article on Publisher Site

Abstract

Objective This systematic review and meta-analysis was performed to investigate the efficacy and safety of transcatheter device closure (TDC) plus anti-thrombotic drugs over medical management alone for patients with cryptogenic stroke and patent foramen oval. Methods PubMed, Embase and Cochrane Library database were searched for randomized controlled clinical trials (RCTs). The primary endpoint is the composite of stroke and transient ischemic attack. The secondary endpoints are all-cause mor- tality, total serious adverse events, atrial fibrillation and bleeding. Results Five RCTs with a total of 3440 participants were included. TDC significantly decreased the risk of primary endpoint when compared to medical therapy alone (RR 0.54, 95% CI 0.43–0.69). Further subgroup analyses showed that patients with male gender and with substantial shunt size of foramen ovale significantly benefited from TDC as compared to those with female gender and with no substantial shunt size of foramen oval separately. Moreover, TDC was superior to medical therapy with anti-platelet drug alone (not with anti-coagulation). On the other hand, the incidence of atrial fibrillation was higher in TDC group (RR 4.49, 95% CI 2.02–9.97), with the risk of other adverse events equivalent between the two groups. Conclusions TDC plus anti-thrombotic drugs is superior than medical

Journal

Journal of Neurology – Springer Journals

Published: Jan 30, 2018

References

  • Heart disease and stroke statistics—2015 update a report from the American Heart Association
    Mozaffarian, D; Benjamin, EJ; Go, AS; Arnett, DK; Blaha, MJ; Cushman, M; Ferranti, S; Després, JP; Fullerton, HJ; Howard, VJ; Huffman, MD; Judd, SE; Kissela, BM; Lackland, DT; Lichtman, JH; Lisabeth, LD; Liu, S; Mackey, RH; Matchar, DB; McGuire, DK; Mohler, ER; Moy, CS; Muntner, P; Mussolino, ME; Nasir, K; Neumar, RW; Nichol, G; Palaniappan, L; Pandey, DK; Reeves, MJ; Rodriguez, CJ; Sorlie, PD; Stein, J; Towfighi, A; Turan, TN; Virani, SS; Willey, JZ; Woo, D; Yeh, RW; Turner, MB
  • Epidemiological transition of stroke in China: twenty-one-year observational study from the Sino-MONICA-Bejing Project
    Zhan, D; Liu, J; Wang, W; Zeng, Z; Cheng, J; Liu, J; Sun, J; Wu, Z
  • Practice advisory: recurrent stroke with patent foramen ovale (update of practice parameter): report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology
    Messe, SR; Gronseth, G; Kent, DM; Kizer, JR; Homma, S; Homma, S; Rosterman, L; Kasner, SE
  • Images in clinical medicine. Paradoxical embolism—thrombus in transit through a patent foramen ovale
    Srivastava, TN; Payment, MF
  • Classification of stroke subtypes
    Amarenco, P; Bogousslavsky, J; Caplan, LR; Donnan, GA; Hennerici, MG
  • Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review
    Khairy, P; O’Donnell, CP; Landzberg, MJ
  • Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies
    Overell, JR; Bone, I; Lees, KR
  • Patent foramen ovale: current pathology, pathophysiology, and clinical status
    Hara, H; Virmani, R; Ladich, E; Mackey-Bojack, S; Titus, J; Reisman, M; Gray, W; Nakamura, M; Mooney, M; Poulose, A; Schwartz, RS
  • Patent foramen ovale: paradoxical embolism and paradoxical data
    Jr, AH
  • Atherosclerotic burden findings in young cryptogenic stroke patients with and without a patent foramen ovale
    Rodes-Cabau, J; Noal, M; Marrero, A; Rivest, D; Mackey, A; Houde, C; Bédard, E; Larose, E; Verreault, S; Peticlerc, M; Pibarot, P; Bogaty, P; Bertrand, OF
  • Management of cryptogenic stroke
    Finsterer, J
  • Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review
    Khairy, P; O’Donnell, CP; Landzberg, MJ
  • Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: a network meta-analysis
    Stortecky, S; Costa, BR; Mattle, HP; Carroll, J; Hornung, M; Sievert, H; Trelle, S; Windecker, S; Meier, B; Jüni, P
  • Closure or medical therapy for cryptogenic stroke with patent foramen ovale
    Furlan, AJ; Reisman, M; Massaro, J; Mauri, L; Adams, H; Albers, GW; Felberg, R; Herrmann, H; Kar, S; Landzberg, M; Raizner, A; Wechsler, L
  • Closure of patent foramen ovale versus medical therapy after cryptogenic stroke
    Carroll, JD; Saver, JL; Thaler, DE; Smalling, RW; Berry, S; MacDonald, LA; Marks, DS; Tirschwell, Tirschwell DL
  • Percutaneous closure of patent foramen ovale in cryptogenic embolism
    Meier, B; Kalesan, B; Mattle, HP; Khattab, AA; Hildick-Smith, D; Dudek, D; Andersen, G; Ibrahim, R; Schuler, G; Walton, AS; Wahl, A; Windecker, S; Jüni, P
  • Long-term outcomes of patent foramen ovale closure or medical therapy after stroke
    Saver, JL; Carroll, JD; Thaler, DE; Smalling, RW; MacDonald, LA; Marks, DS; Tirschwell, DL
  • Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke
    Søndergaard, L; Kasner, SE; Rhodes, JF; Andersen, G; Iversen, HK; Nielsen-Kudsk, JE; Settergren, M; Sjöstrand, C; Roine, RO; Hildick-Smith, D; Spence, JD; Thomassen, L
  • Patent foramen ovale closure or anticoagulation vs antiplatelets after stroke
    Mas, JL; Derumeaux, G; Guillon, B; Massardier, E; Hosseini, H; Mechtouff, L; Arquizan, C; Béjot, Y; Vuillier, F; Detante, O; Guidoux, C; Canaple, S; Vaduva, C; Dequatre-Ponchelle, N; Sibon, I; Garnier, P; Ferrier, A; Timsit, S; Robinet-Borgomano, E; Sablot, D; Lacour, JC; Zuber, M; Favrole, P; Pinel, JF; Apoil, M; Reiner, P; Lefebvre, C; Guérin, P; Piot, C; Rossi, R; Dubois-Randé, JL; Eicher, JC; Meneveau, N; Lusson, JR; Bertrand, B; Schleich, JM; Godart, F; Thambo, JB; Leborgne, L; Michel, P; Pierard, L; Turc, G; Barthelet, M; Charles-Nelson, A; Weimar, C; Moulin, T; Juliard, JM; Chatellier, G
  • Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
    Moher, D; Liberati, A; Tetzlaff, J; Altman, DG
  • Patent foramen ovale closure for secondary prevention of cryptogenic stroke: updated meta-analysis of randomized clinical trials
    Vaduganathan, M; Qamar, A; Gupta, A; Bajaj, N; Golwala, HB; Pandey, A; Bhatt, DL
  • Transcatheter patent foramen ovale closure for secondary prevention of paradoxical embolic events: acute results from the FORECAST registry
    Alameddine, F; Block, PC
  • Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: periprocedural safety and mid-term follow-up results of three different device occluder systems
    Braun, M; Gliech, V; Boscheri, A; Schoen, S; Gahn, G; Reichmann, H; Haass, M; Schraeder, R; Strasser, RH
  • Abstract 8807: efficacy and effectiveness evaluation of secondary prevention of cryptogenic stroke or TIA in patients with PFO successfully treated by percutaneous approach: six years follow-up
    Cillis, ED; Basile, DP; Acquaviva, T; Blasi, RD; Petruzzellis, M; Bortone, AS
  • Transcatheter closure of patent foramen ovale associated with paradoxical embolism using the amplatzer PFO occluder: initial and intermediate-term results of the US multicenter clinical trial
    Hong, TE; Thaler, D; Brorson, J; Heitschmidt, M; Hijazi, ZM
  • Patent foramen ovale after cryptogenic stroke—assessing the evidence for closure
    Farb, A; Ibrahim, NG; Zuckerman, BD