Tailoring antiplatelet therapy duration after PFO closure: insights from the PROLONG registry
C Gaspardone, D Trabattoni, C Fraccaro, F Saia, E Toscano, G Patti, G Ricchetti, A Tripoli, A Beneduce, C S Vella, A Chieffo, M Montorfano, G Tarantini, A Gaspardone, C GodinoAbstract
Background
The optimal duration of antiplatelet therapy (APT) after patent foramen ovale (PFO) device closure remains uncertain.
Objectives
To evaluate the impact of APT duration on long-term outcomes after PFO closure.
Methods
This analysis of the PROLONG (PFO Transcatheter Occlusion Long-Term Outcomes National Group) registry included patients with successful PFO closure, no significant residual shunt, and no other indication for long-term antithrombotic therapy. Patients were categorized according to APT duration after PFO closure into a short-term (≤12 months) or long-term (>12 months) strategy. The primary outcome was net adverse clinical events (NACE), defined as the composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (BARC ≥3). A propensity score was developed, then inverse probability of treatment weighting was applied in HR estimation to account for confounders.
Results
Among 940 patients (mean age 47 ± 12 years; 55% women) followed for 14.0 ± 3.1 years, NACE occurred in 3.7% of those managed with a short-term and 6.3% with a long-term strategy (aHR 0.71; 95% CI 0.38–1.37; p=0.311). In subgroup analysis, short-term APT was associated with significantly lower NACE in patients with RoPE score ≥7 (aHR 0.32; 95% CI 0.11–0.90; p=0.039), but not in those with RoPE <7 (aHR 1.07; 95% CI 0.49–2.35; p=0.891; p for interaction=0.089).
Conclusions
In patients with a RoPE score ≥7, early discontinuation of APT (within 12 months) after effective PFO closure was associated with a lower incidence of net adverse clinical events at long-term follow-up.AlgorithmFor image description, please refer to the figure legend and surrounding text.KM high ropeFor image description, please refer to the figure legend and surrounding text.