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Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review.

Abstract：

BACKGROUND:The optimal strategy to prevent recurrent presumed paradoxical emboli in patients with patent foramen ovale is unknown. PURPOSE:To synthesize the current knowledge about and qualitatively assess the relative benefits of transcatheter closure versus medical therapy for patent foramen ovale. DATA SOURCES:English-language and foreign-language journals listed in the MEDLINE database from January 1985 to July 2003 were systematically searched. Secondary sources were also used. STUDY SELECTION:Secondary prevention studies of transcatheter closure or medical therapy for patent foramen ovale were required to include at least 10 patients followed for more than 1 year and to report recurrent neurologic events. DATA EXTRACTION:Data from published studies were manually extracted and summarized. DATA SYNTHESIS:Ten studies of transcatheter closure (1355 patients) and 6 studies of medical therapy (895 patients) for patent foramen ovale were included. Overall, the 1-year rate of recurrent neurologic thromboembolism with transcatheter intervention was 0% to 4.9%, and the incidence of major and minor complications was 1.5% and 7.9%, respectively. Medical management was associated with a 1-year recurrence rate of 3.8% to 12.0%. However, limitations resulting from uncontrolled data, nonstandardized definitions, vigilance of follow-up, and baseline imbalances preclude definitive conclusions about the superiority of a particular approach. General differences in study samples included older age, greater proportion of men, and higher prevalence of diabetes and smoking among medically treated patients. Patients undergoing treatment with a transcatheter device were more likely to have had multiple thromboembolic events at baseline. CONCLUSION:Transcatheter closure of patent foramen ovale may prevent a substantial proportion of cryptogenic strokes. Randomized clinical trials are needed.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Khairy P,O'Donnell CP,Landzberg MJ

doi

10.7326/0003-4819-139-9-200311040-00010

subject

Has Abstract

pub_date

2003-11-04 00:00:00

pages

753-60

issue

eissn

0003-4819

issn

1539-3704

pii

139/9/753

journal_volume

139

pub_type

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Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review.