Most Read Articles
Roshini Claire Anthony, 2 days ago

A subgroup of patients with HBeAg-negative chronic hepatitis B virus (HBV) infection who ceased their long-term nucleotide analogue treatment maintained virological suppression, pointing to a group of patients who may be suitable for treatment cessation, according to a recent study.

Rachel Soon, 4 days ago

Gels utilizing Stichopus horrens (golden sea cucumber/gamat) extract show a similar efficacy to standard-of-care hydrogels for promoting wound healing, according to a prospective study.

2 days ago
Higher cancer symptom burden in elderly adults is associated with functional impairment, reports a recent study.
Jairia Dela Cruz, 6 days ago
Use of mirabegron in the treatment of men with overactive bladder (OAB) appears to effectively alleviate urgency and storage symptoms, but not reduce the frequency of micturition episodes, according to data from the MIRACLE study.

Preoperative patent foramen ovale ups risk of ischaemic stroke following noncardiac surgery

Tristan Manalac
14 Feb 2018
The more painful the surgery, the more likely addiction is, according to a report by the research firm QuintilesIMS Institute for Healthcare Informatics

Patent foramen ovale (PFO), diagnosed preoperatively, appears to significantly increase the risk of perioperative ischaemic stroke within 30 days after noncardiac surgery, a recent study has shown.

“[H]aving a preoperatively diagnosed PFO was significantly associated with increased risk of perioperative ischemic stroke within 30 days after surgery. Further research is needed to confirm these findings and to determine whether interventions would decrease this risk,” said researchers.

The researchers investigated the incidence of perioperative ischaemic stroke following noncardiac surgery in 150,198 adults (mean age 55±16 years; 54.6 percent female). PFO was preoperatively diagnosed in 1.0 percent of the study cohort.

Perioperative ischaemic stroke was significantly more common in patients with PFO (3.2 vs 0.5 percent; absolute risk difference [RD], 2.6 percent; 95 percent CI, 1.8–3.5). The overall incidence rate of perioperative ischaemic stroke was 0.6 percent (n=850). [JAMA 2018;319:452-462]

The risk of ischaemic stroke within 30 days after the operation was also significantly higher in those with vs without PFO (odds ratio [OR], 2.66; 1.96–3.63; p<0.001), leading to an estimated risk of 5.9 events per 1,000 patients with PFO. The resulting adjusted RD was 0.4 percent (0.2–0.6).

“The association between PFO and stroke remained consistent after adjustment for risk factors of ischemic stroke and multiple sensitivity analyses, including stratified analyses in patients who had received diagnostic tests sensitive for the detection of PFO,” said researchers.

In terms of stroke subtypes, PFO patients were also at a significantly increased risk of large-vessel territory ischaemia (relative risk ratio [RR], 3.14; 2.21–4.48; p<0.001), perioperative total anterior stroke (relative RR, 3.66; 2.20–6.08; p<0.001) and posterior circulation stroke (relative RR, 3.14; 1.75–5.63; p<0.001).

PFO also exacerbated the associated effects of stroke. The stroke-related neurologic deficits, as measured by median scores in the National Institutes of Health Stroke Scale, were more severe in stroke patients with vs without PFO (4 vs 3 points; p=0.02).

“In the current study, PFO-related strokes were more frequently large-vessel territory strokes and strokes with more severe neurological deficits. Patients with PFO also experienced an excess of perioperative complications due to systemic embolism, including acute limb ischemia and renal artery embolism,” said researchers.

“These data provide support for the view of increased vulnerability to thromboembolic complications in patients with PFO during the perioperative period,” they added.

Clinically, the current findings show that patients scheduled for noncardiac surgery and who present with a preoperative diagnosis of PFO are at a higher risk of perioperative ischaemic stroke. This represents an actionable patient subgroup for whom preventive measures, such as preoperative PFO closure and individualized risk-benefit assessment, may potentially be helpful, according to researchers.

“Future studies are required to examine if these patients would benefit from intensifying stroke-preventive measures in the perioperative period,” they said.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 2 days ago

A subgroup of patients with HBeAg-negative chronic hepatitis B virus (HBV) infection who ceased their long-term nucleotide analogue treatment maintained virological suppression, pointing to a group of patients who may be suitable for treatment cessation, according to a recent study.

Rachel Soon, 4 days ago

Gels utilizing Stichopus horrens (golden sea cucumber/gamat) extract show a similar efficacy to standard-of-care hydrogels for promoting wound healing, according to a prospective study.

2 days ago
Higher cancer symptom burden in elderly adults is associated with functional impairment, reports a recent study.
Jairia Dela Cruz, 6 days ago
Use of mirabegron in the treatment of men with overactive bladder (OAB) appears to effectively alleviate urgency and storage symptoms, but not reduce the frequency of micturition episodes, according to data from the MIRACLE study.