A Stroke of Insight: PFO Closure or Antiplatelet Therapy for Stroke and Anticoagulation Education in Atrial Fibrillation
A stroke of insight this week on The Rounds Table; Kieran and Mike share the findings of two exciting new studies. Should a patent foramen ovale (PFO) be closed in the context of cryptogenic stroke? What is the impact of educational intervention surrounding anticoagulation in patients with atrial fibrillation? Listen as Kieran and Mike cover the answers.
We know that greater than five percent of the population has a PFO. Until now, the general consensus has been that the diagnosis of a PFO in someone who has had a stroke is essentially a red herring and does not require specific management. Mike covers an industry sponsored multinational open-label clinical trial looking at outcomes in patients with PFO and cryptogenic stroke randomized to either PFO closure and antiplatelet therapy or antiplatelet therapy alone.
Next, atrial fibrillation is a common condition, affecting 33 million people worldwide. Although anticoagulation in patients with atrial fibrillation dramatically reduces the risk of stroke, the use of anticoagulation is underwhelming. Kieran covers an international cluster randomized controlled trial in which an anticoagulation educational program was delivered to both patients and their providers. The impact of the program on overall anticoagulation rates and concomitant stroke rates was measured.
Finally, the Good Stuff segment. Have you ever been in a public place and heard an overhead call for a medical professional? Heard about the cardiologist who recognised a lecturer’s pulmonary embolism? Kieran and Mike share what they’ve been reading about.
1. PFO and Stroke: http://www.nejm.org/doi/full/10.1056/NEJMoa1707404
2. Educational Intervention for Anticoagulation in AFib: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32165-7/abstract
1. Is there a doctor onboard? https://jamanetwork.com/journals/jama/article-abstract/2653740
2. Ethically Responding to PE: https://www.bostonglobe.com/metro/2017/09/10/how-you-thank-someone-for-saving-your-life/wdjIs3JJZcmX5dQuVFEGVI/story.html
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