Closure Versus Medical Therapy for Preventing Recurrent Stroke in Patients With Patent Foramen Ovale and a History of Cryptogenic Stroke or Transient Ischemic Attack

Abstract

The optimal therapy for preventing recurrent stroke in people with cryptogenic stroke and patent foramen ovale (PFO) has not been defined. The choice between medical therapy (antithrombotic treatment with antiplatelet agents or anticoagulants) and transcatheter device closure has been the subject of intense debate during the past several years. Despite the lack of scientific evidence, a substantial number of people undergo transcatheter device closure (TDC) for secondary stroke prevention. To compare the safety and efficacy of TDC with best medical therapy alone for preventing recurrent stroke (fatal or nonfatal) or transient ischemic attacks (TIAs) in people with PFO and a history of cryptogenic stroke or TIA and to identify specific subgroups of people most likely to benefit from closure for secondary prevention. We searched the Cochrane Stroke Group Trials Register (July 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 2, 2014), MEDLINE (1950 to July 2014), and EMBASE (1980 to July 2014). In an effort to identify unpublished …