Stroke risk and PFO

It is uncertain whether the recurrence rate of stroke in patients with cryptogenic stroke is dependent on the presence of a PFO. In one observational study of patients treated with aspirin, the incidence of recurrent stroke was higher in patients with than without PFO [47]. In a further prospective randomized study, the recurrence rate of stroke was the same in those with or without PFO in those treated with either warfarin or aspirin [44]. The question of whether subjects from the general population with PFO have an increased risk of ischemic stroke has been studied by two prospective cohort studies, which unanimously found that PFO was not a risk factor for future cerebrovascular events [48, 49]. Overall, it has not been demonstrated that patients with PFO are at increased risk of recurrent stroke. Furthermore, it is uncertain how many strokes in PFO patients are due to paradoxical embolism and how to treat paradoxical embolism. Results from randomized clinical trials on these issues are urgently needed.

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