ABSTRACT NUMBER: ESOC2026A2486 MANAGEMENT STRATEGIES AND STROKE RECURRENCE IN PATIENTS WITH PATENT FORAMEN OVALE AND CONCOMITANT THROMBOPHILIA

Abstract Background and aims Patent foramen ovale (PFO) is an important cause of stroke in young patients. Percutaneous PFO closure is recommended for PFO-related stroke and commonly followed by antiplatelet therapy. Concurrent thrombophilia increases risk of venous/arterial thrombus, generally requiring long-term anticoagulation, questioning the clinical benefit of PFO closure in these cases. The best management of this “triple pathology” is still unknown. This study aims to evaluate long-term outcomes of different approaches in PFO-associated stroke patients with concurrent thrombophilia. Methods We conducted a single-center historical cohort study of PFO-associated stroke and concurrent thrombophilia. Major thrombophilias included factor V Leiden mutations, prothrombin G20210A mutations, antithrombin or protein S deficiencies, and antiphospholipid antibody syndrome. The primary outcome was recurrent stroke during follow-up. Results We included 60 patients, mean age 47.2 years (SD: 10.2), mean follow-up time 6.8 years (SD: 4.1). Patients managed with anticoagulation alone (n=21) or with PFO closure followed by anticoagulation (n=10) had no recurrent stroke (median follow-up of 7 years). In patients who closed PFO followed by antiplatelets (n=29), 17% had recurrent PFO-associated stroke, representing an annual stroke rate of 3.7%/year. Recurrent strokes took place 1-8 years after closure (median follow-up of 5 years). Conclusions This study confirms the safety of PFO closure in patients with concomitant thrombophilia and underscores the clinical importance of long-term anticoagulation in reducing the risk of recurrent vascular events. This highlights the importance of evaluating potential thrombophilias in all patients with PFO-related stroke and emphasizes the need for multidisciplinary discussion and individualized management before and after intervention. Conflict of interest All authors: nothing to disclose