Practice advisory update summary: Patent foramen ovale and secondary stroke prevention
Practice advisory update summary: Patent foramen ovale and secondary stroke prevention
复制标题
实践咨询更新摘要：卵圆孔未闭和中风二级预防
作者：
S. Messé;G. Gronseth;D. Kent;J. Kizer;S. Homma;Lee R Rosterman;J. Carroll;Koto Ishida;N. Sangha;S. Kasner
目的更新 2016 年美国神经病学学会 (AAN) 针对中风和卵圆孔未闭 (PFO) 患者的实践建议。方法 指南小组遵循 AAN 2017 指南制定流程，系统地审查截至 2017 年 12 月发表的研究并制定建议。主要建议 对于考虑 PFO 封堵术的患者，临床医生应确保进行适当彻底的评估，以排除其他卒中机制（B 级）。对于已确定具有较高风险替代性卒中机制的患者，临床医生不应常规建议 PFO 封堵（B 级）。临床医生应告知患者 PFO 很常见；一般人群中大约四分之一的成年人会出现这种情况；很难确定 PFO 是否导致中风； PFO 封堵可能会降低特定患者复发性中风的风险（B 级）。对于年龄小于 60 岁、患有 PFO 和栓塞性梗塞且未发现其他卒中机制的患者，临床医生可能会在讨论潜在益处（5 岁时卒中复发风险绝对降低 3.4%）和风险（围手术期并发症发生率为 3.9%，非围手术期心房颤动绝对发生率每年增加 0.33%）后建议终止治疗（C 级）。对于选择单独接受药物治疗而不进行 PFO 封堵的患者，临床医生可能会推荐抗血小板药物，例如阿司匹林或抗凝药物（C 级）。
Objective To update the 2016 American Academy of Neurology (AAN) practice advisory for patients with stroke and patent foramen ovale (PFO). Methods The guideline panel followed the AAN 2017 guideline development process to systematically review studies published through December 2017 and formulate recommendations. Major recommendations In patients being considered for PFO closure, clinicians should ensure that an appropriately thorough evaluation has been performed to rule out alternative mechanisms of stroke (level B). In patients with a higher risk alternative mechanism of stroke identified, clinicians should not routinely recommend PFO closure (level B). Clinicians should counsel patients that having a PFO is common; that it occurs in about 1 in 4 adults in the general population; that it is difficult to determine with certainty whether their PFO caused their stroke; and that PFO closure probably reduces recurrent stroke risk in select patients (level B). In patients younger than 60 years with a PFO and embolic-appearing infarct and no other mechanism of stroke identified, clinicians may recommend closure following a discussion of potential benefits (absolute recurrent stroke risk reduction of 3.4% at 5 years) and risks (periprocedural complication rate of 3.9% and increased absolute rate of non-periprocedural atrial fibrillation of 0.33% per year) (level C). In patients who opt to receive medical therapy alone without PFO closure, clinicians may recommend an antiplatelet medication such as aspirin or anticoagulation (level C).
DOI：
10.1016/s1474-4422(18)30319-3
发表时间：
2018-12
期刊：
The Lancet. Neurology
影响因子：
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作者：
Kasner SE;Swaminathan B;Lavados P;Sharma M;Muir K;Veltkamp R;Ameriso SF;Endres M;Lutsep H;Messé SR;Spence JD;Nedeltechev K;Perera K;Santo G;Olavarria V;Lindgren A;Bangdiwala S;Shoamanesh A;Berkowitz SD;Mundl H;Connolly SJ;Hart RG;NAVIGATE ESUS Investigators
通讯作者：
NAVIGATE ESUS Investigators