Secondary prevention of cerebral ischemia in patent foramen ovale: systematic review and meta-analysis

South Med J. 2001 Jul;94(7):699-703.


Background: Therapy for patent foramen ovale (PFO), found with increased frequency in the setting of stroke in the young, is controversial. We compiled a synthesis of the literature on therapeutic options for PFO and stroke.

Methods: Searching MEDLINE (1966 to 1999), published abstracts, and bibliographies of primary and review articles, we identified five retrospective cohort studies that compared at least two different treatment options (antiplatelet therapy, warfarin, or surgery). Outcomes data on mode of therapy and recurrent stroke were abstracted, and pooled analysis was done using a random effects model.

Results: Warfarin was superior to antiplatelet therapy in preventing recurrent ischemic events (odds ratio [OR] 0.37; 95% confidence interval [CI], 0.23 to 0.60). Surgical PFO closure was comparable to warfarin treatment (OR 1.19; 95% CI, 0.62 to 2.27).

Conclusion: Available data suggest that warfarin is superior to antiplatelet therapy and comparable to surgical PFO closure for the prevention of recurrent cerebral ischemic events from paradoxical embolism.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use*
  • Brain Ischemia* / etiology
  • Brain Ischemia* / prevention & control
  • Heart Septal Defects, Atrial / complications*
  • Humans
  • Male
  • Middle Aged
  • Warfarin / therapeutic use*


  • Anticoagulants
  • Warfarin