SCAI Issues Guidelines for Management of Patent Foramen Ovale

May 19, 2022—The Society for Cardiovascular Angiography & Interventions (SCAI) today released official guidelines for the management of patent foramen ovale (PFO). A multidisciplinary guideline panel formulated 13 recommendations to address five PFO clinical scenarios. SCAI Writing Group Chair Clifford J. Kavinsky, MD, et al published the guidelines in the JSCAI: Journal of the Society for Cardiovascular Angiography & Interventions.

“This document represents the first truly rigorous guideline document put forth by the SCAI to lend clarity to a field surrounded by controversy and to aid physician decision making for PFO-associated conditions,” commented Dr. Kavinsky in the SCAI press release. Dr. Kavinsky is Chief, Section of Structural and Interventional Cardiology at Rush University Medical Center in Chicago, Illinois.

According to SCAI, the guidelines address the following five scenarios where patients and clinicians may consider additional management of a PFO:

• Percutaneous PFO closure versus medical therapy (antiplatelet or anticoagulation or composite)/no therapy in adults without a prior PFO-associated stroke
• Percutaneous PFO closure versus antiplatelet therapy in adults with a prior PFO-associated stroke
• Percutaneous PFO closure versus anticoagulation therapy in adults with a prior PFO-associated stroke 
• Percutaneous PFO closure plus lifelong anticoagulation versus anticoagulation alone in adults with a prior PFO-associated stroke
• Postprocedure management of patients undergoing percutaneous PFO closure with a regimen of 1 month of aspirin plus clopidogrel followed by 5 months of aspirin versus another antiplatelet regimen or anticoagulation

As noted by SCAI, the guideline panel was composed of experts in the fields of structural heart disease and neurology as well as patient representatives. The panel employed the GRADE approach to develop a series of clinical questions and patient-important outcomes. Each question was subjected to a systematic evidence review, which informed judgments by the guideline panel to develop each recommendation.

The press release concluded, “SCAI acknowledges the importance of alignment with stroke neurology for any guidance surrounding PFO closure and carried out this effort with representation from the American Academy of Neurology.”