If a PFO is diagnosed, your doctor will explain that there are several treatment options. They include the following:
Because a stroke is often caused by a blood clot that passes to the brain, it is essential to lower or eliminate the risk of blood clot formation. One way this is accomplished is using medications known as blood-thinners or anticoagulants.
However, these medications, while effective, can cause bruising or it may take more time for bleeding to stop. For most people, the bleeding risk associated with taking blood-thinner medications is less serious than the risks of having a stroke. However, the risk versus benefit of blood thinners varies from one patient to another and they should be thoroughly discussed with your physician. Also, being on blood thinners requires strict adherence to testing and at times certain dietary and lifestyle modifications. More details about living with blood thinners are available here.
The most commonly prescribed anticoagulants are:
- Warfarin (Coumadin™) (Bristol-Myers Squibb Pharma Company) is perhaps the best-known of all the anticoagulant drugs because it has been in use for stroke prevention since the 1950s. Read more about warfarin here.
- Dabigatran (Pradaxa™) (Boehringer Ingelheim Pharma GmbH & Co.) is one of the newer anticoagulants. It is a short-acting medication that does not stay in the bloodstream as long as warfarin. Learn more about dabigatran here.
- Rivaroxaban (Xarelto™) (Bayer Aktiengesellshaft) is an anticoagulant that is taken once daily. Click here to read about rivaroxaban.
- Apixaban (Eliquis™) (Bristol-Myers Squibb Pharma Company) is an anticoagulant that has proven to be effective at reducing the risk of stroke. You can read about apixaban here.
The information about anticoagulants on SecondsCount.org is a general overview. It should not replace talking with your doctor about your specific situation, the treatments that are best for you as well as the benefits and risks of each option. Working with you, your medical team will find the medication that works best for you.
Closure of PFO
Another method of reducing the risk of stroke is to close the PFO so that blood can no longer move across the heart through the patent foramen ovale. If the PFO is closed, a clot forming on the venous side cannot cross through the PFO, and instead of going to the brain would end up in a branch of the lung arteries. A small clot in the lungs is well tolerated and often unnoticeable while the same clot can lead to a major disability if it lodges in the brain.
There are two ways the PFO can be closed off:
While surgical repair of a PFO is feasible and effective, it is rarely done as a standalone procedure because it is invasive surgery, generally known as open heart surgery. Surgical repair of a PFO is often performed while the patient is already undergoing open heart surgery for another reason (valve replacement surgery, for example). However, it is rare that a doctor will order open heart surgery for the purposes of closing a PFO.
One option for closing the PFO without open heart surgery is through the use of a small occluder device that is inserted into the heart through a vein, in a much less invasive manner than open heart surgery would be. This is known as transcatheter closure of the PFO. It is a procedure that was first used successfully in 1989 and has become the treatment method of choice since that time.
The U.S. Food and Drug Administration has approved the use of devices to close a PFO in order to reduce the risk of stroke in cases where a patient has suffered at least one stroke that is cryptogenic, meaning the patient has been examined by both a neurologist and a cardiologist, and it has been determined the stroke cannot be traced back to other risk factors or causes such as atrial fibrillation, carotid artery disease, etc.
Currently, the AMPLATZER™ PFO occluder device (Abbott) is the only device approved by the US Food and Drug Administration for transcatheter closure of a PFO.