Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Medical Association, 325(1), 81–82. https://doi.org/10.1001/jama.2020.22176 Dr. AbdulRahman Dia et al
Points
- Patients considered for PFO closure should be examined via ECG for atrial fibrillation
- Patients >50 y.o. that exhibit other risk factors for atrial fibrillation are monitored for four (4) weeks in total
- Both types of patients must undergo analysis to exclude other alternative causes of ischemic stroke, like small vessel ischemic disease and extracranial/intracranial vessel stenosis
Summary
A patent foramen ovale (PFO), or what we call the hole that forms between the left and right atria of the heart, is relatively common and is known to occur in about one (1) out of four (4) people. The closure of this PFO brings moderate benefits to stroke patients under 60 years of age whose stroke event is likely to be caused by a PFO. This guideline work serves to examine the role PFO closure plays in preventing stroke.
Prior to surgery, all patients considered for PFO closure surgery should have their hearts examined for atrial fibrillation via electrocardiogram (ECG). From there, those who are above 50 years of age that exhibit risk factors for atrial fibrillation (hypertension, obesity, obstructive sleep apnea, etc.) are monitored for another 28 days. Nevertheless, all patients must be examined to exclude alternative causes of ischemic stroke in addition to atrial fibrillation.
From the entries above, a moderate recommendation for PFO closure is provided to patients below 60 years old without another identifiable cause of stroke; however, this is given after a comprehensive workup. For patients who do not go through PFO closure and whose other possible stroke causes have been excluded, antithrombotic treatment is recommended. It must be noted, however, that at this point in time any preference toward either antiplatelet or anticoagulation is unclear.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2774671
References Dia, A., Cifu, A. S., & Shah, A. P. (2021). Management of patients with a patent foramen ovale with history of stroke or tia. JAMA, 325(1), 81–82. https://doi.org/10.1001/jama.2020.22176
