Abstract 13708: Analyzing Outcomes of Atrial Septal Defect Closure in Patients With Ischemic Stroke and Thrombophilia

Introduction: Evidence on outcomes of ASD closure after a stroke in patients with thrombophilia is limited.: We illustrate differences in long-term outcomes amongst patients diagnosed with a stroke and thrombophilia, who underwent ASD closure up to 3 months after the stroke versus those who did not.

Methods: We queried the TriNetX research database to identify adult patients with thrombophilia and ASD who had an ischemic stroke from 2016 to 2021. Patients were divided into two groups: those undergoing percutaneous transcatheter ASD closure within 3 months of the stroke and those who received medical therapy only. Subgroup analyses was performed comparing ASD closure with patients who received either anticoagulation or antiplatelets, and of those with a specific diagnosis of PFO. Propensity score matching (PSM) was used to control for age, sex, hypertensive diseases, CKD, diabetes, dyslipidemias, ischemic heart disease, and tobacco use. Outcomes were measured from 1 month to 3 years after the index event and included all-cause mortality, new onset Atrial fibrillation/flutter, arterial embolism, and services associated with stroke/arterial embolism namely thrombolysis, thrombectomy, and imaging (CT, CTA, MRI, MRA) of head and neck.

Results: Patients with thrombophilia undergoing ASD closure after a stroke had lower all-cause mortality compared to medical therapy [HR 0.35, 95%CI 0.165 - 0.764]. This association persisted on subgroup analysis comparing ASD closure to antiplatelet use only [HR 0.392, 95% CI 0.163,0.947] (Table 1).

Conclusions: ASD closure was associated with lower mortality in patients with thrombophilia and ischemic stroke. There was no statistical difference in incidence of A.fib/flutter, arterial embolism, or services associated to stroke/embolism. There were no differences in outcomes in patients with a specific diagnosis of PFO.