Tailoring Antiplatelet Therapy Duration After PFO Closure
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The optimal duration of antiplatelet therapy (APT) after patent foramen ovale (PFO) device closure remains uncertain. OBJECTIVES: This study aimed to evaluate the impact of APT duration on long-term outcomes after PFO closure. METHODS: PROLONG (PFO Transcatheter Occlusion Long-Term Outcomes National Group; NCT06504121) is a multicenter retrospective registry of patients who underwent PFO device closure between 1999 and 2013 at 12 Italian centers. This analysis included patients with successful PFO closure, no significant residual shunt, and no other indication for long-term antithrombotic therapy. Patients were categorized by APT duration after PFO closure in the discontinuation group (≤12 months) or the continuation group (>12 months). The primary outcome was net adverse clinical events (NACE), a composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (Bleeding Academic Research Consortium ≥3). Inverse probability of treatment weighting was applied for baseline confounders. RESULTS: Among 940 patients (mean age 47 ± 12 years; 55% women) followed for 14.0 ± 3.1 years, the cumulative incidence of NACE was 3.6% in the APT discontinuation group and 7.2% in the APT continuation group (adjusted HR [aHR]: 0.71; 95% CI: 0.38-1.37; P = 0.31). Ischemic events were similar (3.1% vs 4.3%; P = 0.66), while major bleeding was lower in the APT discontinuation group (0.9% vs 2.8%; P = 0.014). APT discontinuation was associated with lower NACE in patients with Risk of Paradoxical Embolism (RoPE) score ≥7 (aHR: 0.32; 95% CI: 0.11-0.90; P = 0.039), but not in those with RoPE <7 (aHR: 1.07; 95% CI: 0.49-2.35; P = 0.89; P for interaction = 0.089). CONCLUSIONS: In patients with a RoPE score ≥7, early discontinuation of APT after effective PFO closure was associated with a lower incidence of NACE at long-term follow-up.
Source: JACC Advances
Authors: Carlo Gaspardone, Daniela Trabattoni, Daniele O. d’Atri, Chiara Fraccaro, Alessandro Beneduce, Michele Morosato, Paolo Costa, Giulio Falasconi, Riccardo Mazza, Riccardo Mager, Andrea Donti, Francesco Saia, Evelina Toscano, Filippo Scalise, Giuseppe Patti, Roberto Nerla, Fausto Castriota, Carmine Musto, Maurizio Paciaroni, Francesco Burzotta, Gianluca Ricchetti, Ciro S. Vella, Luca A. Ferri, Giorgio Bassanelli, Marco B. Ancona, Filippo Russo, Barbara Bellini, Giuseppe Barone, Massimo Slavich, Francesca Napoli, Gabriele Paci, Francesco Versaci, Carlo Pappone, Massimo Mancone, Giuseppe Tarantini, Alaide Chieffo, Marco Metra, Achille Gaspardone, Matteo Montorfano, Cosmo Godino
Institutions: IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, Sapienza University of Rome, Centro Cardiologico Monzino, University of Padua, Vita-Salute San Raffaele University, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Universitat de Barcelona, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, Azienda Ospedaliero Universitaria Maggiore della Carita, Maria Cecilia Hospital, Azienda Ospedaliera San Camillo-Forlanini, University of Ferrara, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Santa Maria Goretti, Policlinico Umberto I, St. Eugenio Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W7166698137