AAN PFO Guidelines Bundle

106 Commerce Street, Suite 105 Lake Mary, FL 32746 TEL: 407.878.7606 • FAX: 407.878.7611 Order additional copies at GuidelineCentral.com Copyright © 2020 All rights reserved Disclaimer Practice advisories published by the American Academy of Neurolog y are assessments of current scientific and clinical information provided as an educational service. e information (1) should not be considered inclusive of all proper treatments or as a statement of the standard of care; (2) is not continually updated and may not reflect the most recent evidence; (3) addresses only the question(s) specifically identified; (4) does not mandate any particular course of medical care; and (5) is not intended to substitute for the independent professional judgment of the treating provider. Use of the information is voluntary. e information is provided "as is" without warranty. AAN assumes no responsibility for any injury to persons arising out of or related to any use of this information or for any errors or omissions. e content of this tool was developed solely by the AAN and adapted by IGC, independent of external influence. Neither IGC, AAN, nor the authors endorse any product or service associated with the distributor of this tool. AANPAT06203 Abbreviations AF, atrial fibrillation; CTA; computed tomographic angiography; HR; hazard ratio; MRA; magnetic resonance angiography; PFO; patent foramen ovale; RR; risk ratio; TCD; transcranial Doppler ultrasonography; TEE; transesophageal echocardiography; TTE; transthoracic echocardiography Source Steven R. Messé, MD; Gary S. Gronseth, MD; David M. Kent, MD, MSc; Jorge R. Kizer, MD, MSc; Shunichi Homma, MD; Lee Rosterman, DO; John D. Carroll, MD; Koto Ishida, MD; Navdeep Sangha, MD; Scott E. Kasner, MD, MSCE. Practice advisory update: Patent foramen ovale and secondary stroke prevention. Report of the Guideline Subcommittee of the American Academy of Neurolog y. Neurolog y 2020;94(20):876-885. is practice advisory was endorsed by the Society for Cardiovascular Angiography and Interventions, the American Heart Association/American Stroke Association, and the European Academy of Neurolog y. Classification of Management Recommendations Classification Definition Level (A) Denotes a practice recommendation that must be done. In almost all circumstances, adherence to the recommendation will improve health- related outcomes. Almost all patients in this circumstance would desire that the recommendation be followed. Level (B) Corresponds to the helping verb should. Should recommendations tend to be more common, as the requirements are less stringent but still based on the evidence and benefit-risk profile. Level (C) Corresponds to the helping verb may. May recommendations represent the lowest allowable recommendation level the AAN considers useful within the scope of clinical practice and can accommodate the highest degree of practice variation. Level (U) Indicates that the available evidence is insufficient to support or refute the efficacy of an intervention. Level (R) Assigned when the balance of benefits and harms is unknown and the intervention is known to be exorbitantly expensive or have important risks. is level designates that the intervention should not be used outside of a research setting. Resources 1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/ HRS guideline for the management of patients with strial fibrillation: a report of the American College of Cardiolog y/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2019;16:e66-e93. 2. Tektonidou MG, Andreoli L, Limper M, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296-1304.

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