Navigating the uncertainties of antithrombotic therapy After transcatheter patent foramen ovale closure: A Comprehensive Review

The patent foramen ovale (PFO), present in 25% of the population, can cause paradoxical embolism and stroke. Transcatheter PFO closure is the gold standard for recurrent embolism with significant inter-atrial shunting, with recent trials confirming its superiority in reducing ischemic stroke recurrence over medical therapy. However, device-related thrombosis remains a concern, posing risks of systemic embolism and neurological events. Optimal post-closure antithrombotic management, including the choice and duration of therapy, remains unclear. Recommendations suggest transient dual antiplatelet therapy followed by long-term single therapy, but robust evidence is lacking, especially regarding device neo-endothelization timelines. Current studies often lack long-term follow-up, leaving gaps in understanding the incidence and prevention of thrombosis. Future research is crucial to provide evidence-based guidance and refine personalized treatment strategies for better outcomes.