Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Schuchlenz, HW; Weihs, W; Berghold, A; Lechner, A; Schmidt, R.
Secondary prevention after cryptogenic cerebrovascular events in patients with patent foramen ovale.
Int J Cardiol. 2005; 101(1):77-82
Doi: 10.1016/j.ijcard.2004.03.005
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Berghold Andrea
- Schmidt Reinhold
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- Abstract:
- Background: Patients with patent foramen ovale and cryptogenic stroke are at risk of recurrence, but there are few data on strategies to prevent this. Methods: We studied 280 consecutive patients with cryptogenic cerebrovascular events and a patent foramen ovale examined by multiplane transesophageal echocardiography. Patients received platelet inhibitors (n = 66) or anticoagulation (n = 47) or underwent device closure (n = 167). During the mean follow-up of 2.6 years, we compared the frequency of recurrent events, death and severe treatment complications. Results: A total of 33 (12%) patients had a recurrent cerebrovascular event. The annual recurrence rates were 13% in patients treated with platelet inhibitors, 5.6% in those on oral anticoagulation, and 0.6% in those after device closure. Independent predictors of recurrent cerebrovascular events were a patent foramen ovale larger than 4 mm (hazard ratio 3.8, 95% CI 1.2-11.2; p = 0.017) or previous strokes (hazard ratio 4.3, 95% CI 2.0-9.2; p < 0.001). Interventional closure of the patent foramen ovale decreased the risk of a recurrent event compared with oral anticoagulation (hazard ratio 0.06, 95% CI 0.12-0.29; p < 0.001), whereas antiplatelet therapy showed a trend to an increased risk (hazard ratio 23; 95% CI 0.9-5.5; p = 0.055). Major side effects occurred in 7 anticoagulated patients and in 13 patients after device closure. There were two non-vascular deaths and one fatal hemorrhagic stroke. Conclusions: Patients with a large patent foramen ovale and a cryptogenic cerebrovascular event had a substantial risk of recurrence even with medical treatment. Risk of recurrence was lower after device closure of the patent foramen ovale. (c) 2004 Elsevier Ireland Ltd. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Anticoagulants - therapeutic use
- Echocardiography, Transesophageal -
- Female -
- Heart Septal Defects, Atrial - physiopathology Heart Septal Defects, Atrial - surgery Heart Septal Defects, Atrial - ultrasonography
- Humans -
- Incidence -
- Ischemic Attack, Transient - etiology Ischemic Attack, Transient - prevention & control Ischemic Attack, Transient - ultrasonography
- Male -
- Middle Aged -
- Platelet Aggregation Inhibitors - therapeutic use
- Proportional Hazards Models -
- Prospective Studies -
- Prosthesis Implantation -
- Recurrence - prevention & control
- Risk Assessment -
- Risk Factors -
- Stroke - etiology Stroke - prevention & control Stroke - ultrasonography
- Time Factors -
- Find related publications in this database (Keywords)
- cryptogenic cerebrovascular events
- patent foramen ovale
- multiplane transesophageal echocardiography