Tailoring Antiplatelet Therapy Duration After PFO Closure: Insights From the PROLONG Registry

doi:10.1016/j.jacadv.2026.102943

Tailoring Antiplatelet Therapy Duration After Patent Foramen Ovale (PFO) Closure: Insights From the PROLONG Registry

JACC AdvPublished 30 Jun 2026multicenter retrospective registry

Main finding · NACE, a composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (Bleeding Academic Research Consortium ≥3)ResultAdjusted hazard ratio 0.71 95% CI 0.38–1.37

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Authors' conclusion

In patients with a RoPE score ≥7, early discontinuation of APT after effective PFO closure was associated with a lower incidence of NACE at long-term follow-up.

Study context

Population: Patients who underwent PFO device closure between 1999 and 2013 at 12 Italian centers, with successful PFO closure, no significant residual shunt, and no other indication for long-term antithrombotic therapymean age 47 ± 12 years, 55% women, followed for 14.0 ± 3.1 years
Participants: 940 patients

Exposure: Antiplatelet therapy (APT) discontinuation vs continuation after PFO closure
Outcome: NACE, a composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (Bleeding Academic Research Consortium ≥3)
Follow-up: 14.0 ± 3.1 years

Methodological detailsInverse probability of treatment weighting

Inverse probability of treatment weighting

Main finding

As reported in the abstract

NACE, a composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (Bleeding Academic Research Consortium ≥3)

Adjusted hazard ratio

0.71

95% CI 0.38–1.37

P = 0.31

By group

APT discontinuation group3.6%cumulative incidence

APT continuation group7.2%cumulative incidence

APT discontinuation group vs APT continuation group

aHR 0.71 (95% CI 0.38–1.37); P = 0.31

Observational data: associations, not effects.

Further findings

Ischemic events

APT discontinuation group3.1%

APT continuation group4.3%

Outcome	← Lower risk with APT discontinuation group ←→ Higher risk with APT discontinuation group →	aHR (95% CI)	P value
NACE by RoPE score (subgroup) · RoPE score ≥7	0.10.31310	0.32 (0.11–0.90)	P = 0.039
NACE by RoPE score (subgroup) · RoPE <7	0.10.31310	1.07 (0.49–2.35)	P = 0.89
	0.10.31310Adjusted hazard ratio (log scale)

Ischemic events: P = 0.66
Net adverse clinical events (NACE) by Risk of Paradoxical Embolism (RoPE) score (subgroup): P for interaction = 0.089

Safety

Major bleeding · lower in the APT discontinuation group

APT discontinuation group0.9%

APT continuation group2.8%

Major bleeding: P = 0.014

Original publication

Tailoring Antiplatelet Therapy Duration After PFO Closure: Insights From the PROLONG Registry. JACC Adv. Published 30 June 2026. doi:10.1016/j.jacadv.2026.102943

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Summarised from the published abstract; every number is checked against it