Risk of ischemic stroke in patients with pulmonary embolism and patent foramen ovale: A systematic review and meta-analysis.

OBJECTIVE

Patients with acute pulmonary hypertension during an acute pulmonary embolism (PE) can develop stroke due to paradoxical embolism in the presence of a patent foramen ovale (PFO). We evaluated the current evidence regarding the risk of ischemic stroke and mortality in patients with PE and a PFO.

METHODS

We performed a systematic review and meta-analysis of studies found on PubMed, the Cochrane Library, Embase, SCOPUS, and the BVS portal. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥18 years) diagnosed with PE and investigating the presence of PFO and new ischemic brain injuries. This study is registered with PROSPERO (CRD42023467133).

RESULTS

The initial search identified 1398 articles. After applying exclusion criteria, only 8 articles remained, including a total of 1197 individuals with PE, among whom PFO was identified in 318 patients. Ischemic stroke occurred in 62/318 (19.5 %) individuals in the PFO group and in 40/879 (4.5 %) individuals in the non-PFO group. The prevalence of ischemic stroke in the PFO group was higher than in the non-PFO group in all eight studies. The meta-analysis showed that PFO was significantly associated with ischemic stroke in patients with PE compared to those without PFO (odds ratio 5.36, 95 % CI 3.20-8.99, p < 0.00001; I² = 0 %). Three studies also reported higher mortality in the PFO group.

CONCLUSION

Patent foramen ovale is a common condition in patients with acute PE and is associated with a higher incidence of ischemic stroke and increased mortality.