What do we know about the benefit of PFO closure compared with warfarin for preventing recurrent stroke?
A comparison of device closure and anticoagulation was not a prespecified analysis in the CLOSE trial (Patent Foramen Ovale Closure or Anticoagulants Versus Antiplatelet Therapy to Prevent Stroke Recurrence), but a post hoc underpowered analysis of recurrent stroke found no events in the device closure group and 3 events in the warfarin group, which was not a statistically significant difference. Therefore, it is not known whether closure is superior to warfarin for preventing recurrent stroke. Further trials and individual-level meta-analysis of all randomized trial data may help to determine the benefit of PFO closure compared with long-term anticoagulation.