Updated meta-analysis on the closure of patent foramen ovale in reduction of stroke rates: the defense-pfo trial does not change the scenario
Rev. bras. cir. cardiovasc
;
33(5): 511-521, Sept.-Oct. 2018. tab, graf
Article
in English
| LILACS
| ID: biblio-977455
ABSTRACT
Abstract Objective:
We aimed to analyze whether patent foramen ovale (PFO) closure reduces the risk of stroke, assessing also some safety outcomes after the publication of a new trial.Introduction:
The clinical benefit of closing a PFO has been an open question, so it is necessary to review the current state of published medical data in regards to this subject.Methods:
MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were used to search for randomized controlled trials (RCTs) that reported any of the followingoutcomes:
stroke, death, major bleeding or atrial fibrillation. Six studies fulfilled our eligibility criteria and included 3560 patients (1889 for PFO closure and 1671 for medical therapy.Results:
The risk ration (RR) for stroke in the "closure" group compared with the "medical therapy" showed a statistically significant difference between the groups, favouring the "closure" group (RR 0.366; 95%CI 0.171-0.782, P=0.010). There was no statistically significant difference between the groups regarding the safety outcomes, death and major bleeding, but we observed an increase in the risk of atrial fibrillation in the "closure" group (RR 4.131; 95%CI 2.293-7.443, P<0.001). We also observed that the larger the proportion of effective closure, the lower the risk of stroke.Conclusion:
This meta-analysis found that stroke rates are lower with percutaneously implanted device closure than with medical therapy alone, being these rates modulated by the rates of hypertension, atrial septal aneurysm and effective closure. The publication of a new trial did not change the scenario in the medical literature.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Stroke
/
Foramen Ovale, Patent
Type of study:
Controlled clinical trial
/
Etiology study
/
Systematic reviews
Limits:
Humans
Language:
English
Journal:
Rev. bras. cir. cardiovasc
Journal subject:
Cardiology
/
General Surgery
Year:
2018
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Pronto Socorro Cardiológico de Pernambuco/BR
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