Patent foramen ovale linked with increased risk of ischemic stroke in PE
Background: Studies have demonstrated the increased risk for ischemic stroke in patients diagnosed with acute PE, and data support the mechanism of paradoxical embolism via PFO. However, the frequency of this phenomenon is unknown and the strength of the association between PFO and ischemic stroke in patients with PE is unclear.
Dr. Caley McIntyre
Study design: Prospective cohort study.
Setting: Four French hospitals.
Synopsis: 315 patients aged 18 years and older presenting with acute symptomatic PE were evaluated at the time of diagnosis for PFO with contrast transthoracic echocardiography and for ischemic stroke with cerebral magnetic resonance imaging. The overall frequency of ischemic stroke at the time of PE diagnosis was high (7.6%), and was nearly four times higher in the PFO group than the non-PFO group (21.4% vs. 5.5%; difference in proportions, 15.9 percentage points; 95% confidence interval, 4.7-30.7).
This study adds to the growing body of data which supports the association of ischemic stroke with PFO and PE. Given the moderate indication for indefinite anticoagulation in patients at high risk for recurrent PE and stroke, there may be a role for screening for PFO in patients with acute PE so that they can be appropriately risk stratified.
Bottom line: The presence of ischemic stroke in patients with acute pulmonary embolism is high, and there is a strong association with PFO.
Citation: Le Moigne E et al. Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism: A Prospective Cohort Study. Ann Intern Med. 2019;170:756-63.
Dr. McIntyre is a hospitalist at Ochsner Health System, New Orleans.
