2018/07/25 by Ton Kuijpers, Frederick A. Spencer, Reed Siemieniuk +17 · 1 citation
Medicine · #Cardiovascular and Diving-Related Complications #Traumatic Brain Injury and Neurovascular Disturbances #Intracranial Aneurysms: Treatment and Complications #Medicine #Patent foramen ovale #Stroke (engine) #Guideline #Context (archaeology) #Atrial fibrillation #Intensive care medicine #Closure (psychology) #Cardiology #Internal medicine
paper · pdf · doi:10.1136/bmj.k2515
openalex publication_date 2018/07/25 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
### What you need to know Options for the secondary prevention of stroke in patients younger than 60 years who have had a cryptogenic ischaemic stroke thought to be secondary to patent foramen ovale (PFO) include PFO closure (with antiplatelet therapy), antiplatelet therapy alone, or anticoagulants. International guidance and practice differ on which option is preferable. The BMJ Rapid Recommendations panel used a linked systematic review1 triggered by three large randomised trials published in September 2017 that suggested PFO closure might reduce the risk of ischaemic stroke more than alternatives.234 The panel felt that the studies, when considered in the context of the full body of evidence, might change current clinical practice.5 The linked systematic review finds that PFO closure prevents recurrent stroke relative to antiplatelet therapy, but possibly not relative to anticoagulants, and is associated with procedural complications and persistent atrial fibrillation.1 The review also presents evidence regarding the role of anticoagulants or antiplatelet therapy when PFO closure is not acceptable or is contraindicated. This expert panel make a