Patent Foramen Ovale May Increase Ischemic Stroke Risk Before Noncardiac Surgery

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The estimated risks for stroke were 5.9 and 2.2 per 1000 patients with and without patent foramen ovale, respectively.
The estimated risks for stroke were 5.9 and 2.2 per 1000 patients with and without patent foramen ovale, respectively.

HealthDay News — For adults undergoing noncardiac surgery, having a preoperatively diagnosed patent foramen ovale (PFO) is associated with increased risk for perioperative ischemic stroke, according to a study published in the Journal of the American Medical Association.

Pauline Y. Ng, MD, from Massachusetts General Hospital in Boston, and colleagues conducted a retrospective cohort study involving 182,393 consecutive adults undergoing noncardiac surgery with general anesthesia. Participants had preoperatively diagnosed PFO, and were followed for perioperative ischemic stroke within 30 days of surgery.

The researchers found that 1540 of the 150,198 patient cases had a diagnosis of PFO before surgery. There were 850 ischemic strokes (0.6%) within 30 days of surgery: 3.2% and 0.5% in patients with and without PFO, respectively. 

Patients with PFO had a significantly increased risk for ischemic stroke compared with those without PFO, in adjusted analyses (odds ratio, 2.66). The estimated risks for stroke were 5.9 and 2.2 per 1000 patients with and without PFO, respectively (adjusted absolute risk difference, 0.4%). The risks for large vessel territory stroke (relative risk ratio, 3.14) and a more severe stroke-related neurologic deficit, measured by the National Institute of Health Stroke Scale (median, 4 vs 3), were increased for patients with PFO.

"Further research is needed to confirm these findings and to determine whether interventions would decrease this risk," the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical industry.

Reference

Ng PY, Ng AKY, Subramaniam B, et al. Association of preoperatively diagnosed patent foramen ovale with perioperative ischemic stroke. JAMA. 2018;319(5):452-462.

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