Transcatheter closure of a patent foramen ovale (PFO) — a small hole in the heart linked to cryptogenic stroke — continues to protect patients from recurrent strokes well over a decade after the procedure. A new study following 301 patients for a median of 15 years found stroke and TIA rates of just 0.27 and 0.46 per 100 patient-years, respectively, offering strong reassurance about the procedure's long-term durability.

The study also tackled a lingering question: how long should patients stay on antithrombotic (blood-thinning) therapy after PFO closure? Patients who stopped therapy at 6 months fared similarly to those who continued longer — but those on longer-term treatment had notably higher bleeding rates. After propensity-score matching, the bleeding differences narrowed but the directional signal remained, suggesting prolonged therapy may carry risk without added ischemic benefit. These findings closely mirror those of the PROLONG registry, lending further weight to the idea that antiplatelet therapy can be safely tapered early in well-selected patients.

Key Takeaways:

• Stroke rate was just 0.27 per 100 patient-years over 15 years of follow-up post-PFO closure
• Longer antithrombotic therapy was linked to higher any-bleeding (6.1% vs. 1.3%) and major bleeding (3.8% vs. 0%) rates vs. short-term therapy
• Experts recommend using the RoPE score and procedural success to guide decisions on when to stop antiplatelet therapy
• Both studies are observational — a randomized trial is still needed to confirm these findings

Why it matters: Most PFO closure patients are relatively young (typically 40–50 years old), making long-term therapy decisions especially consequential. This evidence supports a more tailored, time-limited approach to antithrombotic therapy — potentially sparing patients years of unnecessary medication and bleeding risk.