Abstract W P146: Clinical Characteristics of PFO Stroke in Pregnancy

Abstract

Background: Stroke can be a devastating complication of pregnancy. Patent foramen ovale (PFO), an incomplete closure of antenatal interatrial communication, may cause maternal stroke by allowing venous clots to travel directly to the brain. PFO is common in the general population (approximately 25%) and poses unique challenges during pregnancy. Clinically PFO is thought to increase the risk of stroke during pregnancy due to increased venous hypercoagulability in the peripartum period. However, data on PFO related stroke during pregnancy is lacking. We prospectively study the clinical characteristics of stroke in pregnant patients with and without PFO. Method: Following IRB-approved protocol, we prospectively collected and compared clinical characteristics of pregnant stroke patients with and without PFO over a 25 year period at our medical center. Results: Of 8134 PFO related stroke patients at our center, 24 patients had PFO related stroke during pregnancy. Compared to 46 age-matched pregnant stroke patients without PFO, PFO stroke patients had higher NIHSS scores at presentation (6.1 vs 3.8; P<0.05). While the two groups were similar in conventional risks such as hyperlipidemia, gestational diabetes, smoking, EtOH/drug use (Table), PFO patients had a trend toward lower incidence of hypertension (p=0.054), but statistically significantly higher incidence of hypercoagulable state (p=0.0004), migraine with aura (p=0.006), and May-Thurners Syndrome (p=0.001). (Table). Conclusion: PFO may pose unique risks compared to non-PFO related stroke in pregnancy. Novel risk factors such as May-Thurner’s anatomy, which promote venous clotting with the increase in abdominal girth are important during pregnancy. For high risk individuals (such as those with known hypercoagulable state), screening for PFO may be of clinical utility in preventing strokes. Further studies are ongoing to validate these preliminary findings.