What is the role of Clopidogrel (Plavix) after Patent Foramen Ovale (PFO) closure?

From the Guidelines

Clopidogrel is typically recommended for 1-6 months after patent foramen ovale (PFO) closure, with most protocols suggesting 3 months at a standard dose of 75 mg daily, alongside aspirin (81-325 mg daily), to prevent thrombus formation on the closure device while it endothelializes, reducing the risk of device-related thromboembolism. This recommendation is based on the latest guidelines and evidence, including the 2018 Canadian Stroke Best Practice Recommendations 1 and the 2018 clinical practice guideline on patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke 1. The primary purpose of clopidogrel after PFO closure is to prevent thrombus formation on the closure device, reducing the risk of device-related thromboembolism.

Some key points to consider:

• The duration of clopidogrel therapy may be adjusted based on individual patient factors, such as bleeding risk, other indications for antiplatelet therapy, and the specific closure device used.
• Patients with additional indications for anticoagulation, such as atrial fibrillation, may require different antithrombotic regimens.
• Follow-up echocardiography is typically performed at 3-6 months post-procedure to confirm proper device placement and assess for any residual shunting.
• The 2018 guideline on patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke, recommends PFO closure plus antiplatelet therapy rather than anticoagulant therapy for patients under 60 years old with cryptogenic ischemic stroke and PFO 1.
• The guideline also highlights the importance of considering patient values and preferences, as well as the balance of benefits, harms, and burdens of the procedure, when making treatment decisions 1.

Overall, the use of clopidogrel after PFO closure is an important aspect of preventing thromboembolic complications and ensuring the best possible outcomes for patients with cryptogenic stroke and PFO.

From the Research

Clopidogrel after PFO Closure

• The use of clopidogrel after patent foramen ovale (PFO) closure is not directly addressed in the provided studies.
• However, the studies discuss the use of antiplatelet agents, including clopidogrel, in preventing stroke and other cardiovascular events 2, 3, 4, 5, 6.
• Aspirin is recommended as the treatment in stroke patients with a patent foramen ovale 2.
• Clopidogrel, on the other hand, is a more potent antiplatelet agent that may be preferred over aspirin in certain populations, such as those with a high risk of gastrointestinal bleeding 5.
• The combination of clopidogrel and low-dose direct oral anticoagulants may be considered to minimize thrombotic events while counterbalancing bleeding complications 5.

Antiplatelet Therapy

• Antiplatelet agents, including aspirin and clopidogrel, are used to prevent recurrent stroke and other cardiovascular events 2, 3, 4, 5, 6.
• The choice of antiplatelet agent depends on individual patient factors, such as the risk of bleeding and the presence of other medical conditions 2, 5.
• Platelet function analysis may be used to guide antiplatelet therapy, but the evidence for its effectiveness is limited 6.

Bleeding Risks

• The use of antiplatelet agents, including clopidogrel, is associated with an increased risk of bleeding complications 3, 4, 5.
• The risk of bleeding may be minimized by using low-dose direct oral anticoagulants in combination with clopidogrel 5.
• The benefits and risks of antiplatelet therapy must be carefully weighed in individual patients to determine the most appropriate treatment strategy 2, 3, 5.