Tailoring antiplatelet therapy duration after PFO closure: insights from the PROLONG registry

Following patent foramen ovale (PFO) device closure, the optimal duration of antiplatelet therapy (APT) remains uncertain.

To evaluate the impact of APT duration on long-term outcomes after PFO closure.

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 chronic antithrombotic therapy. Patients were categorized into short-term (≤12 months) and long-term (>12 months) APT groups. The primary outcome was net adverse clinical events (NACE), defined as a composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (BARC ≥ 3).

Among 940 patients (mean age 47 ± 12 years, 55% women), NACE occurred in 3.7% of the short-term and 6.3% of the long-term APT groups over a mean follow-up of 14.0 ± 3.1 years (HR 0.61; 95% CI 0.33–1.10; p=0.101). The difference was mainly driven by fewer major bleeding events (HR 0.32; 95% CI 0.10–0.95; p=0.046). The benefit of short-term APT was evident among patients with a Risk of Paradoxical Embolism (RoPE) score ≥7 (HR 0.35; 95% CI 0.12–0.92; p=0.043), but not in those with lower scores (HR 0.86; 95% CI 0.41–1.79; p=0.683).

In patients with RoPE score ≥ 7, discontinuing antiplatelet therapy within 12 months after PFO closure was associated with fewer net adverse clinical events at long-term follow-up.For image description, please refer to the figure legend and surrounding text.  For image description, please refer to the figure legend and surrounding text.