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Who benefits from percutaneous closure of patent foramen ovale vs medical therapy for stroke prevention? In-depth and updated metaanalysis of randomized trials

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World Journal of Cardiology 2019年第4期11卷 126-136页

作者： Khagendra Dahal Adil Yousuf Hussam Watti brannen liang Sharan Sharma Jharendra Rijal Pavan Katikaneni Kalgi Modi Neeraj TANDon Michael Azrin Juyong Lee Division of Cardiology Department of Medicine Louisiana State University Health Sciences Center Department of Medicine University of Connecticut Health Center Kansas City Heart Rhythm Institute Overland Park Division of Cardiology Hartford Medical Center Cardiology Section Overton Brooks VA Medical Center Division of Cardiology University of Connecticut Health Center

BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains *** To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of *** Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs. Ischemic stroke(IS), transient ischemic attack(TIA), a composite of IS, TIA and systemic embolism(SE), mortality, major bleeding,atrial fibrillation(AF) and procedural complications were the major ***-effects model was used to perform *** Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and SE [0.55(0.32-0.93); P = 0.02] and increased the AF risk [4.79(2.35-9.77); P < 0.0001]. No statistical difference was observed in the risk of TIA [0.86(0.54-1.38); P = 0.54],mortality [0.74(0.28-1.93); P = 0.53] and major bleeding [0.81(0.42-1.56); P = 0.53]between two strategies. Subgroup analyses showed that compared to medical therapy, PFOC reduced the risk of stroke in persons who were males, ≤ 45 years of age and had large shunt or atrial septal *** In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy.

关键词： Patent foramen ovale Stroke Antiplatelet therapy Anticoagulation Metaanalysis

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