Consensus document aims to bring ‘coherence’ to PFO treatment

Eight European scientific societies joined forces to produce what they say is the first interdisciplinary position paper to help clinicians manage patients with patent foramen ovales (PFOs).

Published in the European Heart Journal, the document stresses the importance of patient selection and interdisciplinary decision-making in determining when percutaneous PFO closure is warranted and when medical therapy alone is sufficient.

PFO closure has been associated with lower rates of recurrent stroke following cryptogenic stroke and has also been proven cost-effective for certain populations compared to drug treatment.

But the guideline authors noted, “we are rarely able to be categoric about the role of PFO in any given clinical setting, stressing the need for specific clinical and research approaches for complex scenarios.”

“Most studies on the subject are observational, with an ensuing low certitude of effects and very disparate, often contradictory, clinical choices in different local realms in the absence of official positions,” they wrote.

Those observations spurred the need for the position paper, said lead author Christian Pristipino, MD, with San Filippo Neri Hospital in Rome, and colleagues. The document includes recommendations on PFO diagnosis and treatment—with device and medication suggestions—as well as a review of the current evidence on PFO management.

“In all clinical scenarios, the two main axes guiding assessment and treatment of PFO should be: 1) the probability that any PFO has a relevant role in the observed clinical picture; 2) the likelihood that the observed clinical event will recur,” the authors wrote. “For patients with the highest probability of both, closure of the PFO should be advised. For patients with the lowest probability, medical therapy should be considered. For patients with intermediate probabilities, clinical judgement is required to allow good decision-making in liaison with the patient.”

Pristipino et al. believe their work could “offer coherent strategies” for the treatment of PFOs, as well as guide research to the highest-priority subjects. Read the full guidelines here.