PFO closure in young people

[Animus]

Wondering what everyone's thoughts are on this issue. I know of a young female (30's) that had a recent stroke. No history of them, all clotting tests were negative, she did have a reason to clot, on birth control and was a smoker. All the info I can dredge up (or at least the largest to date studies) say no good evidence for the closure. Was wondering how everyone handles these where they are? Her cards people are telling her the studies such as CLOSURE1, etc do not tell the whole story for her age group and scenario. Do you buy this?

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[josephf1]

we dont close them especially if small
20% of people have them
maybe ASA 81 and go from there

 

[dragonfly99]

It's true that the PFO closure trials were a hodgepodge of people.
That type of person (young age, with presumably otherwise structurally normal heart, not having a fib, etc.), is not typical of most of those trials of PFO closure, that is true. It's also not a very dangerous procedure (PFO closure in cath lab). Even if she gets that done, she would need to take antiplatelet therapy, and nobody can promise her even with PFO closure that her stroke risk is all gone/resolved.
I do not think it would be outside of standard of care to do a PFO closure in this scenario, but you mentioned 2 other reasons for her to have thrombosis - being on OCP's and being a smoker. Those 2 risk factors definitely need to go, and the rest she needs to discuss with the docs who are treating her. We can't really give specific medical advice on this forum without knowing everything about the patient or having seen her.

 

[Animus]

It's true that the PFO closure trials were a hodgepodge of people.
That type of person (young age, with presumably otherwise structurally normal heart, not having a fib, etc.), is not typical of most of those trials of PFO closure, that is true. It's also not a very dangerous procedure (PFO closure in cath lab). Even if she gets that done, she would need to take antiplatelet therapy, and nobody can promise her even with PFO closure that her stroke risk is all gone/resolved.
I do not think it would be outside of standard of care to do a PFO closure in this scenario, but you mentioned 2 other reasons for her to have thrombosis - being on OCP's and being a smoker. Those 2 risk factors definitely need to go, and the rest she needs to discuss with the docs who are treating her. We can't really give specific medical advice on this forum without knowing everything about the patient or having seen her.

I understand, just wanted to see if that was someone trying to get procedures under their belt(and I thought this only because of the data) or if it was reasonable.