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Heghine Khachatryan: PFO, Cryptogenic Stroke, and Factor V Leiden – Closure or Lifelong Anticoagulation?
Heghine Khachatryan/LinkedIn
Mar 17, 2026, 14:58

Heghine Khachatryan: PFO, Cryptogenic Stroke, and Factor V Leiden – Closure or Lifelong Anticoagulation?

Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn:

”PFO, Cryptogenic Stroke, and Factor V Leiden: Closure or Lifelong Anticoagulation?

Clinical decision-making becomes particularly complex when a patient presents with cryptogenic stroke, patent foramen ovale (PFO), and homozygous Factor V Leiden thrombophilia.

The key question often raised in practice is:

Should the PFO be closed, or should the patient remain on long-term anticoagulation alone?

Current evidence suggests that the answer is not straightforward and requires careful patient selection.

Several elements must be evaluated before making a decision:

  • Age of the patient (particularly <60 years)
  • Whether the stroke is truly PFO-associated after a complete diagnostic work-up
  • Presence of venous thromboembolism or paradoxical embolism
  • High-risk PFO anatomy (large shunt, atrial septal aneurysm)
  • Underlying prothrombotic conditions such as Factor V Leiden mutation

In patients with strong evidence suggesting paradoxical embolism, many experts increasingly favor PFO closure combined with antithrombotic therapy, rather than relying on medical therapy alone.

However, Factor V Leiden thrombophilia alone does not necessarily prove that the stroke mechanism is arterial or PFO-mediated, and decisions should always be individualized.

In my view, the optimal strategy often involves multidisciplinary discussion between neurologists, cardiologists, and hematologists.

Personally, in a young patient with cryptogenic stroke, PFO, and homozygous Factor V Leiden, I tend to consider PFO closure plus long-term antithrombotic strategy, rather than leaving the defect open.

But this remains an area where clinical judgment and shared decision-making are critical.

I would be very interested to hear the perspectives of colleagues.

How do you approach patients with PFO, cryptogenic stroke, and inherited thrombophilia?

Do you favor:

  • PFO closure
  • Lifelong anticoagulation
  • A combined strategy?

Your experience and insights would be highly valuable for this discussion.”

Heghine Khachatryan: PFO, Cryptogenic Stroke, and Factor V Leiden - Closure or Lifelong Anticoagulation?

Other posts featuring Heghine Khachatryan on Hemostasis Today.

Anticoagulation Cryptogenic Stroke Factor V Leiden Health Heghine Khachatryan Hematology Hemostasis Hemostasis News Hemostasis Today Medicine PFO Thrombophilia trial septal aneurysm
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