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New research · Cardiology
BMJ (Clinical research ed.) · 4d
Randomized trialBMJ (Clinical research ed.) · 2026

Antithrombotic treatment for migraine in patients with patent foramen ovale: multicentre, randomised, active controlled, open label trial.

Ziping Li, Chuangshi Wang, Yajie Tang … Xiangbin Pan
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CardiologyRandomized trial

Rivaroxaban significantly increased migraine responder rates versus metoprolol.

Antithrombotic treatment for migraine in patients with patent foramen ovale: multicentre, randomised, active controlled, open label trial.

Ziping Li … Xiangbin Pan
BMJ (Clinical research ed.) · 2026
Purpose

To evaluate the efficacy and safety of antithrombotic treatment for migraine prevention in participants with patent foramen ovale (patent foramen ovale).

Methods

1000 adults aged 18-64 years with a diagnosis of migraine for more than one year, experiencing at least four migraine days per month, and with patent foramen ovale confirmed by echocardiography.

n = 1000 adults
Results

rivaroxaban led to a higher percentage of people with fewer migraine days than metoprolol

absolute difference 16.20 (95% CI 6 to 26.40)
null = 0626.40
CI excludes the null - significant
More results

For the primary endpoint, aspirin, clopidogrel, and rivaroxaban were all non-inferior to metoprolol.

Responder rates were 61.7% (148/240) with aspirin, 66.8% (157/235) with clopidogrel, 78.4% (185/236) with rivaroxaban, and 61.8% (144/233) with metoprolol.

More results

Among secondary endpoints, rivaroxaban was associated with greater reductions in migraine days and attacks, higher rates of complete migraine cessation, and greater improvements in migraine specific quality-of-life scores than metoprolol.

No major bleeding events occurred.

“
Conclusion · 1 of 2

The antithrombotic agents evaluated in this trial (aspirin, clopidogrel, and rivaroxaban) were all non-inferior to metoprolol for responder rate in participants with patent foramen ovale and migraine.

Conclusion · 2 of 2

Rivaroxaban also showed superior responder rates over metoprolol without an increase in major bleeding events.

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