PB0965 - Patent foramen ovale closure in ischemic stroke patients with and without thrombophilia: a systematic review and meta-analyses

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Xue Yang Lim, MBBS

House Officer
MOH Holdings
Singapore, Singapore

Co-Author(s)

NG

Nicholas LX Gao

Medical Student
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Singapore, Singapore
WL

Wynne Yu Lee

Medical Student
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Singapore, Singapore
JN

Jia Hui Neo

Medical Student
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Singapore, Singapore
AT

Alethea HE Tan

Medical Student
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Singapore, Singapore
CS

Ching-Hui Sia

Associate Consultant
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Cardiology, National University Heart Centre, Singapore
Singapore, Singapore
YL

Yinghao Lim

Consultant
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Cardiology, National University Heart Centre, Singapore
Singapore, Singapore
YC

Yen Lin Chee

Senior consultant
Division of Hematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore
Singapore, Singapore
JH

Jamie SY Ho

Resident
Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore
Singapore, Singapore
BT

Benjamin YQ Tan

Associate Consultant
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Division of Neurology, Department of Medicine, National University Hospital, National University Health System, Singapore
Singapore, Singapore

Background: Ischemic stroke patients with thrombophilia and patient foramen ovale (PFO) may have an increased risk of recurrent stroke and transient ischemic attack (TIA), and may benefit from PFO closure. However, screening for thrombophilia is not routinely performed and the impact of thrombophilia on prognosis after PFO closure is uncertain.

Aims: We aim to compare the risk of recurrent stroke and TIA after PFO closure in patients with thrombophilia versus those without.

Methods: We performed a systematic review and meta-analyses of the literature, with a comprehensive literature search performed on 12 January 2023. Studies comparing the outcomes of patients with and without thrombophilia after PFO closure were included. The primary outcome evaluated was a recurrence of acute cerebrovascular event (ACE), a composite of recurrent ischemic stroke and recurrent TIA. The secondary outcomes included recurrent ischemic stroke only or TIA only.

Results: A total of 61 studies were screened. Eight studies were included (5 prospective cohort studies and 3 retrospective cohort studies), with a total of 3514 patients. The study characteristics are presented in Table 1. The follow up duration of the studies ranges from an average of 5.3 months to 12 years. There was an increased risk of stroke/TIA in patients with thrombophilia compared to those without thrombophilia after PFO (OR: 1.42, 95% CI: 1.01-1.99, I2=50%). The association between risk of TIA only (OR: 1.36, 95% CI: 0.77-2.41, I2=0%) and stroke only (OR: 1.09, 95% CI: 0.54-2.21, I2=0%) with thrombophilia did not reach statistical significance.

Conclusion(s): There is an increased risk of recurrent cerebral ischemia event in patients with thrombophilia compared to those without thrombophilia after PFO closure. The utility of evaluating for thrombophilia in patients with PFO at high risk of recurrent events post-PFO closure requires further investigation.