PubTransformer

A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

Cryptogenic Strokes and Patent Foramen Ovales: What's the Right Treatment?

Abstract More than 25% of all ischemic strokes per year are cryptogenic, that is, their cause is not determined after an appropriate evaluation. In 1988, it was reported that the incidence of a patent foramen ovale was 30 to 40% in young patients with a cryptogenic stroke compared with 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism, that is, a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation. Few of the patients considered to have paradoxical embolism were shown to have coexistent venous thromboembolism. This suspicion of paradoxical embolism led to thousands of patients undergoing surgical closure of their patent foramen ovale. Surgical closure was replaced by closure of the patent foramen ovale by a variety of transvenous devices. Others recommended anticoagulant or antiplatelet therapy to prevent recurrent ischemic strokes. Three randomized clinical trials totaling more than 2000 patients compared closure of the patent foramen ovale with medical therapy. All 3 trials reported that closure of the patent foramen ovale provided no benefit compared with medical therapy. Subsequent trials have demonstrated no benefit of anticoagulation compared with antiplatelet therapy in patients with cryptogenic strokes with or without a patent foramen ovale. Patients with cryptogenic strokes should be evaluated for the presence of venous thromboembolism. If venous thromboembolism is present, treatment should be the same as for pulmonary embolism: anticoagulation. If venous thromboembolism is not present, antiplatelet therapy is indicated.
PMID
Related Publications

Intermediate and long-term results of transcatheter closure of patent foramen ovale using the amplatzer patent foramen ovale occluder: one case of pulmonary embolism irrespective of patent foramen ovale closure.

Cerebrovascular events on awakening, patent foramen ovale and obstructive sleep apnea syndrome.

Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: a network meta-analysis.

Patent foramen ovale and cryptogenic stroke: the hole story.

Predictors of recurrent events in patients with cryptogenic stroke and patent foramen ovale within the CLOSURE I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale) trial.

Authors

Mayor MeshTerms
Keywords

Cryptogenic strokes

Paradoxical embolism

Patent foramen ovale

Transvenous closure of patent foramen ovale

Journal Title the american journal of medicine
Publication Year Start




PMID- 27566504
OWN - NLM
STAT- In-Data-Review
DA  - 20160827
LR  - 20161025
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Linking)
VI  - 129
IP  - 11
DP  - 2016 Nov
TI  - Cryptogenic Strokes and Patent Foramen Ovales: What's the Right Treatment?
PG  - 1159-1162
LID - S0002-9343(16)30834-8 [pii]
LID - 10.1016/j.amjmed.2016.08.006 [doi]
AB  - More than 25% of all ischemic strokes per year are cryptogenic, that is, their
      cause is not determined after an appropriate evaluation. In 1988, it was reported
      that the incidence of a patent foramen ovale was 30 to 40% in young patients with
      a cryptogenic stroke compared with 25% in the general population. This led to the
      suspicion that cryptogenic strokes were due to paradoxical embolism, that is, a
      venous thrombus crossing a patent foramen ovale to enter the left atrium and then
      the arterial circulation. Few of the patients considered to have paradoxical
      embolism were shown to have coexistent venous thromboembolism. This suspicion of 
      paradoxical embolism led to thousands of patients undergoing surgical closure of 
      their patent foramen ovale. Surgical closure was replaced by closure of the
      patent foramen ovale by a variety of transvenous devices. Others recommended
      anticoagulant or antiplatelet therapy to prevent recurrent ischemic strokes.
      Three randomized clinical trials totaling more than 2000 patients compared
      closure of the patent foramen ovale with medical therapy. All 3 trials reported
      that closure of the patent foramen ovale provided no benefit compared with
      medical therapy. Subsequent trials have demonstrated no benefit of
      anticoagulation compared with antiplatelet therapy in patients with cryptogenic
      strokes with or without a patent foramen ovale. Patients with cryptogenic strokes
      should be evaluated for the presence of venous thromboembolism. If venous
      thromboembolism is present, treatment should be the same as for pulmonary
      embolism: anticoagulation. If venous thromboembolism is not present, antiplatelet
      therapy is indicated.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Dalen, James E
AU  - Dalen JE
AD  - Department of Medicine, University of Arizona College of Medicine, Tucson.
      Electronic address: [email protected]
FAU - Alpert, Joseph S
AU  - Alpert JS
AD  - Department of Medicine, University of Arizona College of Medicine, Tucson.
LA  - eng
PT  - Review
PT  - Journal Article
DEP - 20160824
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
OTO - NOTNLM
OT  - Cryptogenic strokes
OT  - Paradoxical embolism
OT  - Patent foramen ovale
OT  - Transvenous closure of patent foramen ovale
EDAT- 2016/10/25 06:00
MHDA- 2016/10/25 06:00
CRDT- 2016/08/28 06:00
PHST- 2016/08/09 [received]
PHST- 2016/08/09 [accepted]
AID - S0002-9343(16)30834-8 [pii]
AID - 10.1016/j.amjmed.2016.08.006 [doi]
PST - ppublish
SO  - Am J Med. 2016 Nov;129(11):1159-1162. doi: 10.1016/j.amjmed.2016.08.006. Epub
      2016 Aug 24.

<?xml version="1.0" encoding="UTF-8"?>
<b:Sources SelectedStyle="" xmlns:b="http://schemas.openxmlformats.org/officeDocument/2006/bibliography"  xmlns="http://schemas.openxmlformats.org/officeDocument/2006/bibliography" >
</b:Sources>