PFO Closure, Oral Anticoagulants or Antiplatelet Therapy After PFO-associated Stroke in Patients Aged 60 to 80 Years (CLOSE-2)
Cryptogenic Ischemic Stroke, Patent Foramen Ovale
About this trial
This is an interventional prevention trial for Cryptogenic Ischemic Stroke focused on measuring Ischemic stroke, Cryptogenic stroke, Patent foramen ovale, Atrial septal aneurysm, Transcatheter PFO closure, Oral anticoagulants, Antiplatelet therapy, Randomized clinical tria
Eligibility Criteria
Inclusion Criteria:
- Man or woman aged 60 to 80 years.
- Recent (≤ 6 months) ischemic stroke confirmed by cerebral imaging regardless of symptom duration.
Absence of a more probable cause of stroke than PFO after a standardized etiological work-up (see addenda). Presence of a PFO with at least 1 of the 2 following characteristics:
- PFO with large shunt (> 20 microbubbles appearing inthe left atrium within 3 cardiac cycles after opacification of the right atrium) detected spontaneously or during provocative maneuvers,
- PFO with ASA on transesophageal echocardiography (TOE): base of aneurysm >= 15mm and excursion >10 mm.
- Affiliation to a French Health Insurance system. Informed consent.
Exclusion Criteria:
- Life expectancy < 4 years.
- Contraindication to both experimental treatments (PFO closure, oral anticoagulant therapy) or to the reference treatment (antiplatelet therapy) (see paragraph 19.5). Indication to long-term anticoagulant therapy.
- mRS >= 3.
- Presence of other medical conditions that would lead to inability to complete the study or interfere with the assessment of outcomes.
- Previous surgical or transcatheter treatment of PFO or ASA. Expected impossible follow-up or poor compliance.
- Patient unable to understand the informed consent form. Patient under tutorship, curatorship, or legal protection.
Sites / Locations
- CHU Amiens
- CH Arras
- CHU Jean Minjoz
- CHU Bordeaux - GH Pellegrin
- CHRU La Cavale Blanche
- HCL-Groupement Hospitalier Lyon Est
- CHU Côte de Nacre
- Hôpital Henri Mondor
- CHU Dijon-Hôpital François Mitterrand
- CH Grenoble-Site Nord
- CH Versailles-Hôpital Mignot
- CHU Bicêtre
- CHRU Lille-Hôpital Salengro
- Hôpital de la Timone
- Hôpital Gui de Chauliac
- CHRU Nancy-Hôpital central
- CHU Carémeau
- APHP Hôpital Lariboisière
- Hôpital Pitié Salpêtrière
- GHU Paris Psychiatrie et Neurosciences
- Groupe Hospitalier Paris Saint-Joseph
- APHP Hôpital Bichat
- Fondation Adolphe de Rothschild
- CH Perpignan
- CHU La Milétrie
- CHU Rouen-Hôpital Charles-Nicolle
- CH Yves Le Foll
- CHU Nantes-Hôpital Nord Laennec
- CHU Saint-Etienne-Hôpital Nord
- Hôpital Hautepierre
- CHU Toulouse-Hôpital Pierre Paul Riquet
Arms of the Study
Arm 1
Arm 2
Arm 3
Active Comparator
Experimental
Experimental
Antiplatelet therapy
Oral anticoagulants, Direct-Acting
PFO closure
Aspirin OR clopidogrel
Apixaban (5mg twice a day) OR Dabigatran (150 mg twice a day) OR Rivaroxaban (20 mg once a day)
PFO closure followed by dual antiplatelet therapy (aspirin 75 mg/d + clopidogrel 75 mg/d) for 3 months, then by single antiplatelet therapy by aspirin or clopidogrel