Internal Medical Department, Seton Hall University, St. Francis Medical Center, Trenton, New Jersey.
Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania.
Am J Med Sci. 2018 Aug;356(2):103-113. doi: 10.1016/j.amjms.2018.04.004. Epub 2018 Apr 7.
Recent randomized control trials (RCTs) have suggested benefit with transcatheter patent foramen ovale (PFO) closure plus antiplatelet therapy over medical treatment alone for secondary stroke prevention.
Data sources: we searched PubMed and Ovid MEDLINE from the inception until November 10, 2017 for RCTs comparing TPFO closure to medical therapy in patients with a PFO and a history of cryptogenic stroke.
Five RCTs with 3,627 patients (TPFO closure = 1,829 versus medical therapy =1,798) were included. There was a decreased number of post-TPFO closure strokes compared to the medical therapy arm; 53 versus 80 strokes (odds ratio [OR] = 0.61, CI: 0.39-0.94, P = 0.03, I = 17%). Transient ischemic attacks occurred in 43 patients after TPFO closure versus 60 patients in the medical therapy group (OR = 0.80, CI: 0.53-1.19, P = 0.26, I = 0%). There was a higher incidence of atrial fibrillation in the TPFO closure group, which occurred in 75 patients, compared to 12 patients in the medical therapy group (OR = 5.23, CI: 2.17-12.59, P = 0.0002, I = 43%). There was a trend toward a decreased number of neuropsychiatric events in the TPFO closure closure group compared to the medical therapy group; 42 versus 67 neuropsychiatric events (OR = 0.71, CI: 0.48-1.06, P = 0.09, I = 0%).
TPFO closure plus antiplatelet therapy is superior to medical therapy in patients with a PFO and cryptogenic stroke. PFO closure is associated with new-onset atrial fibrillation and a trend toward reduced neuropsychiatric events.
最近的随机对照试验（RCTs）表明，对于继发于隐源性卒中的患者，经导管卵圆孔未闭（PFO）封堵术联合抗血小板治疗优于单纯药物治疗。
数据来源：我们检索了PubMed 和 Ovid MEDLINE 数据库，检索时间截至 2017 年 11 月 10 日，检索对象为比较 PFO 封堵术与药物治疗在 PFO 合并隐源性卒中患者中的 RCTs。
纳入了 5 项 RCTs，共 3627 例患者（PFO 封堵术组 1829 例，药物治疗组 1798 例）。与药物治疗组相比，PFO 封堵术后卒中的数量减少；封堵术后发生 53 例卒中，药物治疗组发生 80 例卒中（比值比 [OR] = 0.61，95%CI：0.39-0.94，P = 0.03，I² = 17%）。TPFO 封堵术后发生短暂性脑缺血发作的患者 43 例，药物治疗组 60 例（OR = 0.80，95%CI：0.53-1.19，P = 0.26，I² = 0%）。PFO 封堵组的房颤发生率高于药物治疗组，PFO 封堵组 75 例患者发生房颤，药物治疗组 12 例（OR = 5.23，95%CI：2.17-12.59，P = 0.0002，I² = 43%）。与药物治疗组相比，PFO 封堵组的神经精神事件数量有减少趋势；PFO 封堵组发生 42 例神经精神事件，药物治疗组发生 67 例（OR = 0.71，95%CI：0.48-1.06，P = 0.09，I² = 0%）。
与药物治疗相比，对于 PFO 合并隐源性卒中的患者，PFO 封堵术联合抗血小板治疗更有效。PFO 封堵术会导致新发房颤，且有减少神经精神事件的趋势。
