Current guidance for closure of PFO

Current guidance for closure of patent foramen ovale (PFO) in patients with PFO and cryptogenic stroke:

American Academy of Neurology 2017

• PFO v medical therapy alone—Clinicians must counsel patients considering percutaneous PFO closure that having a PFO is common in the general population; it is impossible to determine with certainty whether their PFO caused their stroke or transient ischaemic attack; the effectiveness of the procedure for reducing stroke risk remains uncertain; and the procedure is associated with relatively uncommon, yet potentially serious, complications

• Anticoagulation v antiplatelet—In the absence of another indication for anticoagulation, clinicians may routinely offer antiplatelet drugs instead of anticoagulation to patients with cryptogenic stroke and PFO

American Heart Association/American Stroke Association

• For patients with an ischaemic stroke or transient ischaemic attack and a PFO who are not undergoing anticoagulation therapy, antiplatelet therapy is recommended
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  For patients with an ischaemic stroke or transient ischaemic attack and both a PFO and a venous source
  of embolism, anticoagulation is indicated depending
  on stroke characteristics. When anticoagulation is contraindicated, an inferior vena cava filter is reasonable
• For patients with a cryptogenic ischaemic stroke or transient ischaemic attack and a PFO without evidence for deep vein thrombosis, available data do not support a benefit for PFO closure
• In the setting of PFO and deep vein thrombosis, PFO closure by a transcatheter device might be considered depending on the risk of recurrent deep vein thrombosis
  NICE 2013

• Evidence on the safety of percutaneous closure of PFO to prevent recurrent cerebral embolic events shows serious but infrequent complications. Evidence on its efficacy is adequate. Therefore, this procedure may be used with normal arrangements for clinical governance, consent, and audit

Netherlands Society of Cardiology 2016

• Closure of a PFO is not beneficial in unselected patients with transient ischaemic attack or cryptogenic stroke
• Closure of a PFO should be considered in patients with
  transient ischaemic attack or cryptogenic stroke and a Risk of Paradoxical Embolism (RoPE) score >8 and at least one clinical risk factor