The size of PFO on the incidences of stroke and migraine

Abstract Background and purposes : Optimal treatment approaches for patients with both patent foramen ovale (PFO) and hypercoagulable state remain uncertain. This study aimed to introduce a novel therapeutic strategy involving the combination of anticoagulant and antiplatelet medications following PFO closure. Methods Consecutive patients diagnosed as PFO and hypercoagulable state were enrolled in this real-world case-control study between January 2021 and January 2022. After PFO closure, patients received either a combination of anticoagulant and mono antiplatelet therapy (anticoagulant group)or dual antiplatelet therapy(antiplatelet group) as part of their post-procedural management. Follow-up outcomes encompassed cessation of clinical symptoms, recurrence of neurological events, major bleeding episodes, and mortality. Results The final analysis comprised 38 eligible patients. Following PFO closure, of whom 17 patients were treated with a combination of anticoagulant and mono antiplatelet therapy, others treated with dual antiplatelet therapy. Over the one-year treatment period, significant differences were observed in alleviating migraine and prevention of recurrent stroke between the anticoagulant group and the antiplatelet group (p < 0.05). No instances of bleeding events and recurrent stroke were recorded during follow-up. Conclusions For patients with both PFO and hypercoagulable state, long-term therapy involving anticoagulants and mono antiplatelet agents post PFO closure may be a viable option. However, further validation through multicenter and extensive clinical trials is warranted.