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Article: Patent foramen ovale and long-term risk of ischaemic stroke after surgery
Title | Patent foramen ovale and long-term risk of ischaemic stroke after surgery |
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Authors | |
Keywords | Patent foramen ovale Stroke Paradoxical embolism Surgery Antithrombotic agents |
Issue Date | 2019 |
Publisher | Oxford University Press. The Journal's web site is located at http://eurheartj.oxfordjournals.org/ |
Citation | European Heart Journal, 2019, v. 40 n. 11, p. 914-924 How to Cite? |
Abstract | Aims:
Pre-operatively diagnosed patent foramen ovale (PFO) is associated with an increased risk of ischaemic stroke within 30 days after surgery. This study aimed to assess the PFO-attributable ischaemic stroke risk beyond the perioperative period.
Methods and results:
This observational study of adult patients without history of stroke undergoing non-cardiac surgery with general anaesthesia examined the association of PFO with ischaemic stroke 1 and 2 years after surgery using multivariable logistic regression. Of the 144 563 patients included, a total of 1642 (1.1%) and 2376 (1.6%) ischaemic strokes occurred within 1 and 2 years after surgery, 54 (4.7%) and 76 (6.6%) among patients with PFO, and 1588 (1.1%) and 2300 (1.6%) among patients without PFO, respectively. The odds of ischaemic stroke within 1 and 2 years after surgery were increased in patients with PFO: adjusted odds ratio (aOR) 2.01, 95% confidence interval (CI) 1.51–2.69; P < 0.001 and aOR 2.10, 95% CI 1.64–2.68; P < 0.001, respectively. Among patients who underwent contrast transoesophageal echocardiography, the frequency of PFO was 27%, and the increased stroke risk in patients with PFO was robust (aOR 3.80, 95% CI 1.76–8.23; P = 0.001 for year 1). The PFO-attributable risk was mitigated by post-operative prescription of combination antithrombotic therapy (odds ratio 0.41, 95% CI 0.22–0.75; P for interaction = 0.004).
Conclusion:
Patients with PFO are vulnerable to ischaemic stroke for an extended period of time after surgery. Physicians should consider implementing PFO screening protocols in patients scheduled for major non-cardiac surgery. |
Persistent Identifier | http://hdl.handle.net/10722/272929 |
ISSN | 2023 Impact Factor: 37.6 2023 SCImago Journal Rankings: 4.091 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Friedrich, S | - |
dc.contributor.author | Ng, PY | - |
dc.contributor.author | Platzbecker, K | - |
dc.contributor.author | Burns, SM | - |
dc.contributor.author | Banner-Goodspeed, V | - |
dc.contributor.author | Weimar, C | - |
dc.contributor.author | Sabramaniam, B | - |
dc.contributor.author | Houle, TT | - |
dc.contributor.author | Bhatt, DL | - |
dc.contributor.author | Eikermann, M | - |
dc.date.accessioned | 2019-08-06T09:19:15Z | - |
dc.date.available | 2019-08-06T09:19:15Z | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | European Heart Journal, 2019, v. 40 n. 11, p. 914-924 | - |
dc.identifier.issn | 0195-668X | - |
dc.identifier.uri | http://hdl.handle.net/10722/272929 | - |
dc.description.abstract | Aims: Pre-operatively diagnosed patent foramen ovale (PFO) is associated with an increased risk of ischaemic stroke within 30 days after surgery. This study aimed to assess the PFO-attributable ischaemic stroke risk beyond the perioperative period. Methods and results: This observational study of adult patients without history of stroke undergoing non-cardiac surgery with general anaesthesia examined the association of PFO with ischaemic stroke 1 and 2 years after surgery using multivariable logistic regression. Of the 144 563 patients included, a total of 1642 (1.1%) and 2376 (1.6%) ischaemic strokes occurred within 1 and 2 years after surgery, 54 (4.7%) and 76 (6.6%) among patients with PFO, and 1588 (1.1%) and 2300 (1.6%) among patients without PFO, respectively. The odds of ischaemic stroke within 1 and 2 years after surgery were increased in patients with PFO: adjusted odds ratio (aOR) 2.01, 95% confidence interval (CI) 1.51–2.69; P < 0.001 and aOR 2.10, 95% CI 1.64–2.68; P < 0.001, respectively. Among patients who underwent contrast transoesophageal echocardiography, the frequency of PFO was 27%, and the increased stroke risk in patients with PFO was robust (aOR 3.80, 95% CI 1.76–8.23; P = 0.001 for year 1). The PFO-attributable risk was mitigated by post-operative prescription of combination antithrombotic therapy (odds ratio 0.41, 95% CI 0.22–0.75; P for interaction = 0.004). Conclusion: Patients with PFO are vulnerable to ischaemic stroke for an extended period of time after surgery. Physicians should consider implementing PFO screening protocols in patients scheduled for major non-cardiac surgery. | - |
dc.language | eng | - |
dc.publisher | Oxford University Press. The Journal's web site is located at http://eurheartj.oxfordjournals.org/ | - |
dc.relation.ispartof | European Heart Journal | - |
dc.rights | Pre-print: Journal Title] ©: [year] [owner as specified on the article] Published by Oxford University Press [on behalf of xxxxxx]. All rights reserved. Pre-print (Once an article is published, preprint notice should be amended to): This is an electronic version of an article published in [include the complete citation information for the final version of the Article as published in the print edition of the Journal.] Post-print: This is a pre-copy-editing, author-produced PDF of an article accepted for publication in [insert journal title] following peer review. The definitive publisher-authenticated version [insert complete citation information here] is available online at: xxxxxxx [insert URL that the author will receive upon publication here]. | - |
dc.subject | Patent foramen ovale | - |
dc.subject | Stroke | - |
dc.subject | Paradoxical embolism | - |
dc.subject | Surgery | - |
dc.subject | Antithrombotic agents | - |
dc.title | Patent foramen ovale and long-term risk of ischaemic stroke after surgery | - |
dc.type | Article | - |
dc.identifier.email | Ng, PY: pyeungng@hku.hk | - |
dc.identifier.authority | Ng, PY=rp02517 | - |
dc.description.nature | link_to_OA_fulltext | - |
dc.identifier.doi | 10.1093/eurheartj/ehy402 | - |
dc.identifier.pmid | 30020431 | - |
dc.identifier.pmcid | PMC6416532 | - |
dc.identifier.scopus | eid_2-s2.0-85055870647 | - |
dc.identifier.hkuros | 300514 | - |
dc.identifier.volume | 40 | - |
dc.identifier.issue | 11 | - |
dc.identifier.spage | 914 | - |
dc.identifier.epage | 924 | - |
dc.identifier.isi | WOS:000462575700013 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 0195-668X | - |