@article{3020214,
    title = "Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated meta-analysis",
    author = "Angelini, F. and Fortuni, F. and Tsivgoulis, G. and Agnelli, G. and Bocchino, P.P. and Franchin, L. and De Filippo, O. and Bellettini, M. and D’Ascenzo, F. and Crimi, G. and Leonardi, S. and De Ferrari, G.M. and Paciaroni, M.",
    journal = "Cardiovascular Drugs and Therapy",
    year = "2021",
    volume = "35",
    number = "5",
    pages = "987-993",
    publisher = "Springer-Verlag",
    issn = "0920-3206, 1573-7241",
    doi = "10.1007/s10557-020-07068-9",
    keywords = "acetylsalicylic acid;  anticoagulant agent;  antithrombocytic agent;  apixaban;  clopidogrel;  dabigatran;  dipyridamole;  rivaroxaban;  ticlopidine;  anticoagulant agent;  antithrombocytic agent, adult;  all cause mortality;  anticoagulant therapy;  Article;  bleeding;  cerebrovascular accident;  comparative effectiveness;  drug safety;  female;  human;  male;  meta analysis;  middle aged;  patent foramen ovale;  recurrent disease;  transient ischemic attack;  bleeding;  brain ischemia;  patent foramen ovale, Anticoagulants;  Foramen Ovale, Patent;  Hemorrhage;  Humans;  Ischemic Stroke;  Platelet Aggregation Inhibitors;  Recurrence",
    abstract = "Purpose: Patients with patent foramen ovale (PFO) and cryptogenic ischemic stroke (CS) are at risk for stroke recurrence. The optimal antithrombotic strategy in patients who undergo medical management is still debated. Methods: We systematically searched the literature for studies that reported on cerebrovascular event recurrences and/or death in patients with PFO treated with oral anticoagulation (OAC) or antiplatelet therapy (APT) for secondary prevention of CS. The efficacy endpoints were stroke recurrence and the composite of stroke, transient ischemic attack or all-cause death. Major bleedings represented the safety endpoint. Results: A total of 16 studies with 3953 patients (OAC = 1527, APT = 2426) were included. Weighted mean follow-up was 2.9 years. OAC was associated with a significant reduction in the risk of stroke compared with APT (RR 0.65; 95% CI 0.44–0.95; ARR 2%, NNT 49), while no difference was found regarding the composite outcome (RR 0.78; 95% CI 0.57–1.07) and the safety outcome (RR 1.57; 95% CI 0.85–2.90; p = 0.15). Conclusions: OAC was more effective than APT in reducing the risk of stroke recurrence in patients with PFO and CS, without a significant increase in the risk of major bleedings. Our findings support the need for further randomized data focused on the comparison of antithrombotic strategies in this setting. © 2020, Springer Science+Business Media, LLC, part of Springer Nature."
}