経皮的卵円孔開存閉鎖術後の抗血栓薬はどうするか

抄録

Percutaneous patent foramen ovale (PFO) closure has become an established treatment for selected patients with cryptogenic stroke and PFO in Japan. Although randomized controlled trials have demonstrated the efficacy of PFO closure for secondary stroke prevention, the optimal strategy and duration of antithrombotic therapy after the procedure remain unclear.

Antithrombotic therapy after PFO closure serves two main purposes. In the short term, it is essential to prevent device–related thrombosis until endothelialization is completed, which is generally considered to occur within approximately six months. Current Japanese guidance recommends dual antiplatelet therapy followed by single antiplatelet therapy in patients without an indication for anticoagulation, whereas continued anticoagulation with short–term antiplatelet therapy is advised for patients with an indication for anticoagulation, such as patients with venous thromboembolism. In the long term, the need for ongoing antithrombotic therapy should be individualized according to the risk of recurrent ischemic stroke and other thrombotic disorders.

Recent observational studies and Japanese post–marketing surveillance data suggested that discontinuation of antithrombotic therapy after a certain period may be feasible in carefully selected patients, particularly those who are younger, have fewer vascular risk factors, and have higher Risk of Paradoxical Embolism (RoPE) scores. In the absence of randomized trials focusing on post–closure antithrombotic management, individualized decision–making remains essential.