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Recent ischemic stroke more common in patients with both PE, patent foramen ovale

Patients hospitalized for pulmonary embolism were four times more likely to have had a recent ischemic stroke if they also had patent foramen ovale, according to a study published in the Annals of Internal Medicine.

“Several studies have reported increased risk for recent ischemic stroke at the acute phase of pulmonary embolism in association with patent foramen ovale,” Emmanuelle Le Moigne, MD, PhD, of Brest University Hospital at Western Brittany University in France, and colleagues wrote. “However, the frequency of the paradoxical embolism mechanism in patients with pulmonary embolism and the strength of the association between stroke and patent foramen ovale remain uncertain.”

To compare the frequency of recent silent or symptomatic ischemic stroke in patients with acute pulmonary embolism based on whether they had patent foramen ovale, researchers conducted a prospective cohort study of 324 patients with documented pulmonary embolism who were hospitalized at one of four French hospital centers from November 2009 through December 2015. Among those patients, 43 had patent foramen ovale.

Patients hospitalized for pulmonary embolism were four times more likely to have had a recent ischemic stroke if they also had patent foramen ovale.

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Using clinical examination and cerebral MRI, which were completed within 7 days of enrollment, researchers then determined if patients had a recent ischemic stroke.

Researchers found that recent ischemic stroke was more frequent in patients with patent foramen ovale than those without (21.4% vs. 5.5%).

“Our findings have important clinical implications for pulmonary embolism management,” the researchers wrote. “The presence of patent foramen ovale was associated with increased risk for stroke; hence, systematic screening for patent foramen ovale could be justified with the aim of identifying patients at risk for ischemic stroke who would be eligible for indefinite anticoagulation to prevent both recurrent pulmonary embolism and stroke. Nevertheless, whether patients with pulmonary embolism should be screened for patent foramen ovale in daily practice remains to be determined.” – by Melissa J. Webb

Disclosures: Le Moigne reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.