Department of Cardiology, Hospital Lillebaelt, Vejle, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Am J Case Rep. 2020 Jul 6;21:e922467. doi: 10.12659/AJCR.922467.
BACKGROUND Transient atrial fibrillation (AF) following percutaneous patent foramen ovale (PFO) closure is common. Anticoagulation therapy should be considered in selected cases of prolonged AF after PFO closure, but guidelines do not provide clear recommendations on indication or choice of anticoagulant therapy for patients with post-procedural AF. CASE REPORT A 45-year-old woman presented with cryptogenic stroke verified by magnetic resonance imaging (MRI). Echocardiography revealed a PFO, which was closed percutaneously using a Gore septal occluder (25 mm). She was discharged on aspirin monotherapy (75 mg oral daily) according to institutional standard. Three weeks later, she presented with atrial fibrillation (AF). A direct oral anticoagulant (DOAC) (rivaroxaban 20 mg once daily) was initiated and aspirin was discontinued. After 4 months of follow-up, a routine echocardiography revealed large thrombi attached to both sides of the PFO occluder. CONCLUSIONS DOACs may be ineffective in preventing thrombus formation on device surfaces. Until more evidence has been provided, we suggest that DOACs are not routinely used for stroke prevention in patients following PFO closure or similar procedures within the first 3 months after device implantation.
经皮卵圆孔未闭（PFO）封堵术后常出现短暂性心房颤动（AF）。对于 PFO 封堵术后持续性 AF 患者，应考虑抗凝治疗，但指南并未就此类患者的抗凝治疗适应证或药物选择提供明确建议。
一名 45 岁女性因磁共振成像（MRI）证实的隐源性卒中就诊。超声心动图显示存在 PFO，使用 Gore 隔瓣封堵器（25mm）经皮关闭 PFO。根据机构标准，患者出院时接受阿司匹林单药治疗（75mg 口服，每日 1 次）。3 周后，患者出现心房颤动（AF）。开始给予直接口服抗凝剂（DOAC）（利伐沙班 20mg，每日 1 次），并停用阿司匹林。随访 4 个月后，常规超声心动图显示 PFO 封堵器两侧附有大血栓。
DOAC 可能无法有效预防器械表面血栓形成。在提供更多证据之前，我们建议在 PFO 封堵或类似器械植入后 3 个月内，DOAC 不常规用于预防此类患者的卒中。
