SCAI Clinical Practice Guidelines on Management of Patent Foramen Ovale-Key Takeaways for Physicians

Key Takeaways for Physicians

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The Society for Cardiovascular Angiography & Interventions (SCAI) has released guidelines for the management of patent foramen ovale (PFO), which is a common condition where there is a small opening between the right and left atria of the heart. The guidelines provide recommendations for various clinical scenarios related to PFO.<br /><br />For adults without a prior PFO-associated stroke, the guidelines suggest against routine PFO closure for the treatment of migraine. However, patients with debilitating migraines who have not benefited from conventional therapy can consider PFO closure. The guidelines also recommend against routine PFO closure for SCUBA divers with prior decompression illness or for individuals with atrial septal aneurysm or deep vein thrombosis without a prior PFO-associated stroke.<br /><br />In adults with a prior PFO-associated stroke, the guidelines recommend PFO closure rather than antiplatelet therapy alone for patients between the ages of 18 and 60. For patients 60 years or older, the guidelines suggest PFO closure rather than long-term antiplatelet therapy alone. The guidelines do not recommend routine PFO closure for patients with a history of atrial fibrillation who have had an ischemic stroke.<br /><br />The guidelines also provide recommendations for adults with a prior PFO-associated stroke and other indications for long-term anticoagulation. In these cases, the guidelines suggest PFO closure in addition to lifelong antithrombotic therapy for patients with thrombophilia or deep vein thrombosis requiring anticoagulation. For patients with a history of pulmonary embolism requiring anticoagulation, PFO closure plus lifelong anticoagulation is suggested.<br /><br />The guidelines do not recommend a specific duration for dual antiplatelet therapy after PFO closure.<br /><br />These guidelines were developed based on systematic reviews of evidence and follow best practices for guideline development. The strength of the recommendations is indicated as either strong or conditional, depending on the level of certainty in the evidence. The guidelines aim to assist clinicians and patients in making informed decisions regarding the management of PFO.

Keywords

Society for Cardiovascular Angiography & Interventions

guidelines

patent foramen ovale

PFO management

migraine treatment

PFO closure

antiplatelet therapy

stroke prevention

thrombophilia

anticoagulation