RoPE Score Calculator
Age
Other criteria
Trials informing thresholds
PFO closure trials whose patient stratification operationalized the RoPE risk concept. The score estimates how likely the PFO is causal rather than incidental, which is the premise every PFO management decision rests on.
- CLOSE2017
Cryptogenic stroke <60y with PFO + atrial septal aneurysm OR large shunt. PFO closure + antiplatelet abolished recurrent stroke vs antiplatelet alone (0% vs 6.0%, HR 0.03, NNT 20 over 5y). AF excess 4.6% vs 0.9%.
- RESPECT (long-term)2017
Cryptogenic stroke 18–60y with PFO. Extended 5.9-year follow-up of Amplatzer PFO Occluder vs medical therapy: recurrent ischemic stroke 3.6% vs 5.8% (HR 0.55, P=0.046, NNT 42). VTE higher with closure.
- REDUCE2017
Cryptogenic stroke 18–59y with PFO. Gore HELEX/Cardioform closure + antiplatelet vs antiplatelet alone: clinical stroke 1.4% vs 5.4% (HR 0.23, P=0.002, NNT ~28 over 2y). AF excess 6.6% vs 0.4%.
Where this score is used
- PFO closure for cryptogenic stroke?From the early trials that missed their primary endpoint (CLOSURE-I, PC, RESPECT 2013) to the positive 2017 cluster and DEFENSE-PFO; AF excess is the trade-off
- PFO and stroke: anticoagulate or antiplatelet?When the PFO is not closed. No adequately powered trial has ever tested this; every dataset is a subgroup