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Cryptogenic Stroke and Patent Foramen Ovale: Optimizing the Reduction in Recurrent Ischemic Events
Başlık:
Cryptogenic Stroke and Patent Foramen Ovale: Optimizing the Reduction in Recurrent Ischemic Events
Yazar:
Kwartler, Alyssa, author.
ISBN:
9780438202634
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (38 pages)
Genel Not:
Source: Masters Abstracts International, Volume: 57-06M(E).
Advisors: Joseph Safdieh Committee members: Gary Bouchard; Shari LeFauve; Gerard Marciano.
Özet:
Problem: There is a significant correlation between presence of patent foramen ovale (PFO), cryptogenic stroke (CS) and risk of recurrent ischemic stroke, specifically in patients under 60 years of age. A superior therapeutic option for preventing recurrent stroke continues to be unclear. Previous randomized controlled trials (RCTs) which compare therapeutic options show trends towards percutaneous closure as a preferential option however, due to lacking statistically significant evidence, medical therapy with antiplatelet regimens continues to be the treatment of choice in most patients. Recently, the use of direct oral anticoagulants (DOACs) has been discussed given the thromboembolic etiology of stroke in these patients along with their safe and efficacious drug profile. To date, there are no studies that accurately discuss the use of DOACs as a therapeutic option for reducing the incidence of recurrent stroke in CS patients with PFO as compared with closure and other medical therapies. Purpose: To compare closure of PFO with medical therapies (antiplatelet, traditional oral anticoagulation, and DOACs) as therapeutic options for preventing recurrent ischemic events. Research Questions: Is medical therapy superior to percutaneous closure in preventing recurrent ischemic events? Specifically, is DOAC therapy as effective other antithrombotic therapies or closure? Additionally, are fewer adverse events associated with DOACs as compared with traditional medical therapies and closure? Ultimately, what is the role of DOAC therapy in CS patients with PFO in preventing recurrent ischemic strokes? effective as traditional oral anticoagulation or antiplatelet therapy? Methods: A systemic review was conducted using the terms "patent foramen ovale" AND "[cryptogenic] stroke", "patent foramen ovale" AND "closure", "patent foramen ovale" AND "medical therapy", "patent foramen ovale" AND "closure" and other similar searches. Outcomes: Initial search yielded a large number of articles including various case reports, literature reviews, meta-analyses and clinical trials on the topic. Articles published within the past 15 years in English and those including human subjects were included. Ultimately, 4 RCTs, 1 non-randomized controlled trial, and an observational study all of which explored medical and percutaneous interventions were discussed. Benefit: Gaps in research surrounding the use of DOACs for CS patients with PFO leave unanswered questions regarding what the optimal therapeutic option is for the prevention of recurrent ischemic events. Although the use of traditional oral anticoagulants like warfarin have been studied, DOACs have not. A study which explores the use of DOACs in this patient population is needed in order to gather data regarding their role as a therapeutic option for preventing recurrent strokes as compared with current standards of care.
Notlar:
School code: 0967
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(688717.1) | 688717-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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