SCAI Guidelines for the Management of PFO Closure Address Trial-Excluded Groups
Patent Foramen Ovale (PFO) Closure guidelines released by the Society for Cardiovascular Angiography and Interventions (SCAI) addressed patient groups who were not included in the randomized controlled trials (RCTs). These groups include patients who are advanced in age or who have certain rare conditions (like platypnea-orthodeoxia and systemic thromboembolism) are now included in the guidelines, which represent a “significant volume of accumulated clinical experience” but not a significant number of patients to allow for RCTs. These guidelines are now in line with the practice advisory update summary from the American Academy of Neurology (AAN).
For adults without a prior PFO-associated stroke, the guidelines recommended against the routine use of PFO closure for the treatment of migraine, SCUBA divers with prior decompression illness, thrombophilia, atrial septal aneurysm, prior transient ischemic attack (TIA) and history of deep vein thrombosis (DVT). However, PFO closure was recommended in systemic embolism without other embolic etiologies.
For adults with a prior PFO-associated stroke, the guidelines recommended PFO closure rather than antiplatelet medication alone for patients ages 18 to 60 plus. It is also recommended for patients with thrombophilia on antiplatelet therapy who are not anticoagulated. The procedure is not recommended for patients with a history of atrial fibrillation (AF) who have had an ischemic stroke.
PFO Closure for stroke prophylaxis may be appropriate on a case by case basis, including planned surgical procedures that are high risk for venous thrombosis such as lower extremity joint replacement; long-term use of hormonal therapy; and patients with indwelling transvenous pacemaker leads or central venous catheters that are not on anticoagulants.
