Published Online
on November 22, 2006

A more recent version of this article appeared on January 1, 2007

This Article Full Text (PDF) All Versions of this Article: 38/1/100    most recent 01.STR.0000251712.55322.69v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bédard, E. Articles by Bertrand, O. F. Search for Related Content PubMed PubMed Citation Articles by Bédard, E. Articles by Bertrand, O. F. Related Collections Coagulation Catheter-based coronary and valvular interventions: other Anticoagulants Antiplatelets Platelets

Submitted on June 27, 2006
Revised on August 13, 2006
Accepted on August 22, 2006

Enhanced Thrombogenesis but Not Platelet Activation Is Associated With Transcatheter Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke

Elisabeth Bédard MD; Josep Rodés-Cabau MD, FESC^*; Christine Houde MD; Ariane Mackey MD; Donald Rivest MD; Stéphanie Cloutier MD; Martin Noël MS; Alier Marrero MD; Jean-Marc Côté MD; Philippe Chetaille MD; George Delisle MD; Marie-Helene Leblanc MD; and Olivier F. Bertrand MD, PhD

From the Institut de Cardiologie de Québec-Hôpital Laval (E.B., J.R.-C., M.N., M.-H.L., O.F.B.), Centre Hospitalier Universitaire Laval (C.H., J.-M.C., P.C., G.D.), Hôpital de l’Enfant-Jesus (A.M., S.C., A.M.), and Hôtel Dieu de Lévis (D.R.), Québec, Canada.

^* To whom correspondence should be addressed. E-mail: josep.rodes{at}crhl.ulaval.ca.

Background and Purpose--No studies have yet determined whether antiplatelet or anticoagulant therapy is the more appropriate treatment after transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke. The objective of this study was to prospectively evaluate the presence, degree, and timing of activation of the platelet and coagulation systems after transcatheter closure of PFO in patients with cryptogenic stroke.

Methods--Twenty-four consecutive patients (mean age, 44±10 years; 11 men) with previous cryptogenic stroke who had undergone successful transcatheter closure of PFO were included in the study. Prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin III (TAT) were used as markers of coagulation activation, and soluble P-selectin and soluble CD40 ligand were used as markers of platelet activation. Measurements of all hemostatic markers were taken at baseline just before the procedure and at 7, 30, and 90 days after device implantation.

Results--F1+2 and TAT levels increased from 0.41±0.16 nmol/L and 2.34±1.81 ng/mL, respectively, at baseline to a maximal value of 0.61±0.16 nmol/L and 4.34±1.83 ng/mL, respectively, at 7 days, gradually returning to baseline levels at 90 days (P<0.001 for both markers). F1+2 and TAT levels at 7 days after PFO closure were higher than those obtained in a group of 25 healthy controls (P<0.001 for both markers). Levels of soluble P-selectin and soluble CD40 ligand did not change at any time after PFO closure.

Conclusions--Transcatheter closure of PFO is associated with significant activation of the coagulation system, with no increase in platelet activation markers. These findings raise the question of whether optimal antithrombotic treatment after PFO closure should be short-term anticoagulant rather than antiplatelet therapy.

Key words: coagulation • cryptogenic stroke • patent foramen ovale • platelets • transcatheter closure

This article has been cited by other articles:

				A.-R. Fathi, P. Eshtehardi, and B. Meier Patent foramen ovale and neurosurgery in sitting position: a systematic review Br. J. Anaesth., May 1, 2009; 102(5): 588 - 596. [Abstract] [Full Text] [PDF]

				F. Pelliccia, C. Cianfrocca, V. Pasceri, A. Granatelli, G. Speciale, A. Roncella, M. Turturo, G. Richichi, and C. Pristipino Transcathether occlusion of interatrial communications: postprocedural transoesophageal echocardiography allows timely detection and treatment of intracardiac thrombus formation Eur J Echocardiogr, May 1, 2009; 10(3): 439 - 441. [Abstract] [Full Text] [PDF]

				A. Undas, P. Podolec, K. Zawilska, M. Pieculewicz, I. Jedlinski, E. Stepien, E. Konarska-Kuszewska, P. Weglarz, M. Duszynska, E. Hanschke, et al. Altered Fibrin Clot Structure/Function in Patients With Cryptogenic Ischemic Stroke Stroke, April 1, 2009; 40(4): 1499 - 1501. [Abstract] [Full Text] [PDF]

				J. Rodes-Cabau, M. Noel, A. Marrero, D. Rivest, A. Mackey, C. Houde, E. Bedard, E. Larose, S. Verreault, M. Peticlerc, et al. Atherosclerotic Burden Findings in Young Cryptogenic Stroke Patients With and Without a Patent Foramen Ovale Stroke, February 1, 2009; 40(2): 419 - 425. [Abstract] [Full Text] [PDF]

				A. Giardini and A. Donti Enhanced Thrombogenesis is Physiologic After Transcatheter Closure of Patent Foramen Ovale Stroke, July 1, 2007; 38(7): e55 - e55. [Full Text] [PDF]

				J. Rodes-Cabau, E. Bedard, O. F. Bertrand, and C. Houde Response to Letter by Giardini and Donti Stroke, July 1, 2007; 38(7): e56 - e56. [Full Text] [PDF]