Letter by Doshi et al Regarding Article, "Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis".

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HomeStrokeVol. 49, No. 5Letter by Doshi et al Regarding Article, “Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Doshi et al Regarding Article, “Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis” Rajkumar Doshi, MD, MPH Neelesh Gupta, MD Vineet Meghrajani, MD Rajkumar DoshiRajkumar Doshi Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY Search for more papers by this author Neelesh GuptaNeelesh Gupta Department of Internal Medicine, University of South Alabama, Mobile Search for more papers by this author Vineet MeghrajaniVineet Meghrajani Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY Search for more papers by this author Originally published11 Apr 2018https://doi.org/10.1161/STROKEAHA.118.021173Stroke. 2018;49:e211Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2018: Previous Version 1 To the Editor:We read with great interest the article by Ntaios et al.1 The authors concluded that patent foramen ovale (PFO) closure devices are associated with lower rates of ischemic stroke recurrence when compared with medical therapy. However, atrial fibrillation rates were higher, although transient, with PFO closure devices. This systemic review and meta-analysis has the potential to affect the guidelines. However, before these results gain wider uptake, a few concerns should be clarified.The study should have been registered with PROSPERO (An International Prospective Register of Systematic Reviews), an international database of prospectively registered systematic reviews in health and social care, to avoid unplanned duplication and to enable the comparison of reported review methods with what was planned in the protocol.They could have provided relevant details on several impactful variables, including the effect of atrial septal aneurysm, size of the shunt, and age of the patient. Perhaps, a sensitivity analysis or meta-regression could have been done as well.They could have mentioned the effectiveness of the closure. The previously published CLOSE (Patent Foramen Ovale Closure or Anticoagulants Versus Antiplatelet Therapy to Prevent Stroke Recurrence),2 gore REDUCE (GORE® HELEX® Septal Occluder / GORE® CARDIOFORM Septal Occluder and Antiplatelet Medical Management for Reduction of Recurrent Stroke or Imaging-Confirmed TIA in Patients With Patent Foramen Ovale),3 and RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment)4 trials revealed the direct association between PFO closure and the risk of stroke: more successful closures were associated with a reduction in stroke rates.It would be interesting to understand relevant major bleeding-related complications in PFO closure devices.This study failed to demonstrate the reduced transient ischemic attack with PFO closure device. However, a previous analysis using similar trials demonstrated beneficial effects with PFO closure device in reducing transient ischemic attack.5 Gore REDUCE can be added in the mixed device study as they have used 2 types of closure devices.Rajkumar Doshi, MD, MPHDepartment of CardiologyNorth Shore University Hospital, Northwell HealthManhasset, NYNeelesh Gupta, MDDepartment of Internal MedicineUniversity of South AlabamaMobileVineet Meghrajani, MDDepartment of Internal MedicineMaimonides Medical CenterBrooklyn, NYDisclosureNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 4 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited.