Determinants of antithrombotic choice for patent foramen ovale in cryptogenic stroke

Thaler, David E.; Ruthazer, Robin; Weimar, Christian; Serena, Joaquín; Mattle, Heinrich P.; Nedeltchev, Krassen; Mono, Marie-Luise; Di Angelantonio, Emanuele; Elkind, Mitchell S.V.; Di Tullio, Marco R.; Homma, Shunichi; Michel, Patrik; Meier, Bernhard; Furlan, Anthony J.; Lutz, Jennifer S.; Kent, David M. (2014). Determinants of antithrombotic choice for patent foramen ovale in cryptogenic stroke. Neurology, 83(21), pp. 1954-1957. Lippincott Williams & Wilkins 10.1212/WNL.0000000000001007

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Objective: We examined the influence of clinical, radiologic, and echocardiographic characteristics on antithrombotic choice in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO), hypothesizing that features suggestive of paradoxical embolism might lead to greater use of anticoagulation.

Methods: The Risk of Paradoxical Embolism Study combined 12 databases to create the largest dataset of patients with CS and known PFO status. We used generalized linear mixed models with a random effect of component study to explore whether anticoagulation was preferentially selected based on the following: (1) younger age and absence of vascular risk factors, (2) “high-risk” echocardiographic features, and (3) neuroradiologic findings.

Results: A total of 1,132 patients with CS and PFO treated with anticoagulation or antiplatelets were included. Overall, 438 participants (39%) were treated with anticoagulation with a range (by database) of 22% to 54%. Treatment choice was not influenced by age or vascular risk factors. However, neuroradiologic findings (superficial or multiple infarcts) and high-risk echocardiographic features (large shunts, shunt at rest, and septal hypermobility) were predictors of anticoagulation use.

Conclusion: Both antithrombotic regimens are widely used for secondary stroke prevention in patients with CS and PFO. Radiologic and echocardiographic features were strongly associated with treatment choice, whereas conventional vascular risk factors were not. Prior observational studies are likely to be biased by confounding by indication.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Mattle, Heinrich; Mono, Marie-Luise and Meier, Bernhard


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Daria Vogelsang

Date Deposited:

06 Feb 2015 09:36

Last Modified:

07 Feb 2015 04:29

Publisher DOI:


PubMed ID:





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