A Systematic Review On The Preventing Recurrence Of Cryptogenic Stroke Associated With Patent Foramen Ovale

Objective The first aim of this study is to compare the effectiveness and safety of PFO closure and medical therapy for preventing recurrence of cryptogenic stroke associated with PFO through a meta-analysis.The second aim of this study is to compare the effectiveness and safety of antiplatelet versus anticoagulant for preventing recurrence of cryptogenic stroke associated with PFO through a meta-analysis.Methods Study I:The databases including PubMed,EMbase,Web of Science,Cochrane Library,China Biomedical Literature Database,Wangfang and China National Knowledge Internet were retrieved by computer,and also supplemented by manual and other retrievals.The studies on the effectiveness and safety of PFO closure and medicine for preventing recurrence of cryptogenic stroke associated with PFO were collected.The deadline of the retrieval time was January 2019.Language is only available in English and Chinese.After two reviewers independently retrieve literature and extract datas according to the inclusion and exclusion criteria,Reyman 5.3 software was used to make statistical analysis.Study ?:The databases including PubMed,EMbase,Web of Science,Cochrane Library,China Biomedical Literature Database,Wangfang and China National Knowledge Internet were retrieved by computer,and also supplemented by manual and other retrievals.The studies about antiplatelet and anticoagulant preventing recurrence of cryptogenic stroke or TIA associated with patent foramen ovale were collected.The deadline of the retrieval time was January 2019.Language is only available in English and Chinese.After two reviewers independently retrieve literature and extract datas according to the inclusion and exclusion criteria,Revman 5.3 software was used to make statistical analysis.Results Study I:A total of 5 paper were enrolled,they are randomized controlled trials,including 3627 patients.Compared with medical therapy,PFO closure can significantly reduce in the recurrence rate of stroke(OR=0.43,95%CI:0.21?0.90,P=0.02).There was no significant difference in reduceing recurrence of TIA between the two groups(OR=0.79,95%CI:0.53-1.19,P=0.26).In the newly diagnosed atrial fibrillation,PFO closure group was significantly higher than medical therapy group(OR=4.93,95%CI:1.74-13.94,P=0.003).The incidence of adverse events such as all-cause mortality(OR=0.79,95%CI:0.39-1.61,P=0.52)and major bleeding(OR=0.76,95%CI:0.32-1.81,P=0.54)was no significant difference between the two groups.Study ?:A total of 14 papers were enrolled,including 5 randomized controlled trials and 9 Case-control studies,including 2725 patients.Compared with antiplatelet,anticoagulant can significantly reduce in the recurrence rate of sroke(OR=2.08,95%CI:1.22-3.54,P=0.007)and recurrence rate of stroke/TIA(OR=1.40,95%CI:1.05-1.85,P=0.02).However,There was no significant difference in reduceing recurrence of TIA(OR=1.62,95%CI:0.97-2.72,P=0.07).In terms of security,anticoagulant is significantly higher than antiplatelet and are 6 times greater than antiplatelet(OR=0.21,95%CI:0.09~0.49,P=0.00040;0.7%versus 4.5%).There was no significant difference in the rate of death between the two groups(OR=1.14,95%CI:0.33-3.96,P=0.84).Conclusion Study I:In preventing recurrence of cryptogenic stroke associated with PFO,PFO closure results in a significant reduction in the recurrence rate of stroke compared to medical therapy.But at the same time patients with PFO closure have a higher risk of atrial fibrillation.Study ?:In the selection of antithrombotic therapy strategies for preventing recurrence of cryptogenic stroke associated with PFO,anticoagulant can significantly reduce the recurrence rate of stroke and the recurrence rate of stroke/TIA.However,the safety of anticoagulant is poor,the bleeding rate of anticoagulant is significantly higher than that of antiplatelet.