What role do anticoagulants play in the management of patients with a PFO and a history of stroke?

Anticoagulants are not routinely recommended solely for the management of patients with a patent foramen ovale (PFO) and a history of stroke. The use of anticoagulation in stroke management is generally guided by the underlying cause of the stroke rather than the presence of a PFO alone. For patients with stroke associated with other specific conditions such as atrial fibrillation or cerebral venous sinus thrombosis, anticoagulation is indicated according to established guidelines. However, in the context of PFO, the decision to use anticoagulants should be individualized based on the overall stroke risk profile and other comorbidities, as there is no direct recommendation to use anticoagulants solely for PFO-related stroke prevention in the provided UK guidelines.

Antiplatelet therapy rather than anticoagulation is often considered for secondary stroke prevention unless there is another indication for anticoagulation, such as atrial fibrillation. Aspirin monotherapy is not recommended solely for stroke prevention in atrial fibrillation, but this does not directly apply to PFO management. Therefore, anticoagulants may be considered if there is an additional indication like atrial fibrillation or venous thromboembolism, but not solely for PFO-related stroke prevention.