Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 1, pp 74–76 | Cite as

PFO closure for secondary stroke prevention: is the discussion closed?

  • Joseph J. ShatzelEmail author
  • Molly M. Daughety
  • Vinay Prasad
  • Thomas G. DeLoughery
Letter to the Editor


Three previous reports of PFO closure for secondary stroke prevention failed to find any significant benefit. Recently however, three conflicting reports were published suggesting a benefit in select patients. Although we are enthusiastic for PFO closure in appropriate patients, caution is warranted in the extrapolation of this data and the application of this intervention to broader patient groups. Only small minorities of stroke patients are likely to benefit from PFO closure, the intervention has a notable complication rate, and it has not been compared against modern anticoagulation options. Clinicians should consider all of these points as discussions around PFO closure are likely to become more and more common going forward.


PFO Stroke PFO closure Anticoagulation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Mas JL, Derumeaux G, Guillon B et al (2017) Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 377:1011–1021CrossRefPubMedGoogle Scholar
  2. 2.
    Saver JL, Carroll JD, Thaler DE et al (2017) Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 377:1022–1032CrossRefPubMedGoogle Scholar
  3. 3.
    Sondergaard L, Kasner SE, Rhodes JF et al (2017) Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 377:1033–1042CrossRefPubMedGoogle Scholar
  4. 4.
    Furlan AJ, Reisman M, Massaro J et al (2012) Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 366:991–999CrossRefPubMedGoogle Scholar
  5. 5.
    Carroll JD, Saver JL, Thaler DE et al (2013) Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med 368:1092–1100CrossRefPubMedGoogle Scholar
  6. 6.
    Meier B, Kalesan B, Mattle HP et al (2013) Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 368:1083–1091CrossRefPubMedGoogle Scholar
  7. 7.
    Meier B, Nietlispach F (2017) Editorial commentary: Closure of the patent foramen ovale viewed from a different angle. Trends Cardiovasc Med 27:582–584CrossRefPubMedGoogle Scholar
  8. 8.
    De Rosa S, Sievert H, Sabatino J et al (2018) Percutaneous closure versus medical treatment in stroke patients with patent foramen ovale: a systematic review and meta-analysis. Ann Intern Med. PubMedCrossRefGoogle Scholar
  9. 9.
    Hagen PT, Scholz DG, Edwards WD (1984) Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 59:17–20CrossRefPubMedGoogle Scholar
  10. 10.
    Connolly SJ, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817CrossRefPubMedGoogle Scholar
  11. 11.
    Bien JY, Daughety MM, Tao DL et al (2017) The safety of aspirin vs. direct oral anticoagulants: a meta-analysis of currently published clinical trials. Blood 130:3720Google Scholar
  12. 12.
    Shah R, Nayyar M, Jovin IS et al (2018) Device closure versus medical therapy alone for patent foramen ovale in patients with cryptogenic stroke: a systematic review and meta-analysis. Ann Intern Med. CrossRefPubMedGoogle Scholar
  13. 13.
    Li L, Yiin GS, Geraghty OC et al (2015) Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. Lancet Neurol 14:903–913CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Chai-Adisaksopha C, Crowther M, Isayama T et al (2014) The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood 124:2450–2458CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Joseph J. Shatzel
    • 1
    • 2
    Email author
  • Molly M. Daughety
    • 1
  • Vinay Prasad
    • 1
  • Thomas G. DeLoughery
    • 1
  1. 1.Department of Hematology, Knight Cancer InstituteOregon Health and Science UniversityPortlandUSA
  2. 2.Department of Hematology & OncologyOregon Health & Science UniversityPortlandUSA

Personalised recommendations