A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis

Chan, Kwan-Leung; Dumesnil, Jean G.; Čujec, Bibiana; Sanfilippo, Anthony J.; Jue, John; Turek, Michèle; Robinson, Trevor I.; Moher, David

doi:10.1016/s0735-1097(03)00829-5

Cited by 215 publications

(104 citation statements)

References 36 publications

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“…However, in a randomized study by Chan et al [25], antiplatelet therapy was not associated with a reduced risk of embolic events when used as adjunctive therapy in combination with antibiotics. Accordingly, in our study, the ‘protective’ effect of anticoagulant therapy disappeared after the initiation of antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

Major Cerebral Events in <i>Staphylococcus Aureus</i> Infective Endocarditis: Is Anticoagulant Therapy Safe?

et al. 2009

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Objectives: To study the impact of anticoagulation on major cerebral events in patients with left-sided Staphylococcus aureus infective endocarditis (IE). Methods: A prospective cohort study; the use of anticoagulation and the relation to major cerebral events was evaluated separately at onset of admission and during hospitalization. Results: Overall, 70 out of 175 patients (40%; 95% CI: 33–47%) experienced major cerebral events during the course of the disease, cerebral ischaemic stroke occured in 59 patients (34%; 95% CI: 27–41%), cerebral infection in 23 patients (14%; 95% CI: 9–19%), and cerebral haemorrhage in 5 patients (3%; 95% CI: 0.5–6%). Patients receiving anticoagulation were less likely to have experienced a major cerebral event at the time of admission (15%) compared with those without anticoagulation (37%, p = 0.009; adjusted OR: 0.27; 95% CI: 0.075–0.96; p = 0.04). In-hospital mortality was 23% (95% CI: 17–29%), and there was no significant difference between those with or without anticoagulation. Conclusions: We found no increased risk of cerebral haemorrhage in S. aureus IE patients receiving anticoagulation. Anticoagulation was associated with a reduced risk of cerebral events before initiation of antibiotics. Data support the continuance of anticoagulation in S. aureus IE patients when indicated.

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Section: Discussionmentioning

confidence: 99%

Major Cerebral Events in <i>Staphylococcus Aureus</i> Infective Endocarditis: Is Anticoagulant Therapy Safe?

et al. 2009

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“…Previously, Nicolau et al [2,3] demonstrated that aspirin was effective in reducing the size of vegetations and the prevention of septic emboli in animal models of endocarditis. However, a randomized trial in humans not only failed to show a reduction in the number of clinically significant embolic events, but patients treated with aspirin had an increase in bleeding events [4]. Nevertheless, this study did not address the question of what to do in the setting of patients already on anticoagulant therapy at the time of diagnosis.…”

Section: Commentsmentioning

confidence: 88%

Clinical Trial Report: Is It Safe to Continue Anticoagulation Therapy in Patients with Infective Endocarditis?

Levine

2010

Curr Infect Dis Rep

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“…Die einzige randomisierte Studie über die Wirkung einer thrombozytenaggregationshemmenden Therapie bei Endokarditis konnte keine Risikoreduktion für das Auftreten systemischer Embolien zeigen [3]. Trotz vielversprechender experimenteller Untersuchungen sind die Ergebnisse einer antithrombotischen Therapie unter klinischen Bedingungen widersprüchlich.…”

Section: Das Risiko Einer Akuten Zerebralen Oder Systemischen Embolunclassified

Die infektiöse Endokarditis bei Intensivpatienten

Dietz

Lemm

Raaz

et al. 2012

Med Klin Intensivmed Notfmed

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Infectious endocarditis is a rare disease with high mortality. Epidemiological changes in recent years, the emergence of new risk factors, and the increasing use of intravasal prosthetic materials has led to changes in not only the clinical appearance of this disease but also in its diagnosis and treatment. Early diagnosis of infectious endocarditis is crucial. However, the often unspecific symptoms and the changes in its epidemiologic profile pose a challenge for the treating physician. This is especially true since the incidence of hospital-acquired, "nosocomial" cases of infectious endocarditis is increasing and often affects severely ill patients in intensive care units (ICU). There are diagnostic and therapeutic algorithms to guide the physician from an early diagnosis to an adequate treatment of the disease. In some critically ill patients, only surgery in combination with antimicrobial treatment may lead to complete eradication of the infectious disease. This review aims to subsume the guidelines, paying special attention to aspects that are important for intensive care and emergency doctors.

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A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis

Abstract: In endocarditis patients already receiving antibiotic treatment, the addition of aspirin does not appear to reduce the risk of embolic events and is likely associated with an increased risk of bleeding. Aspirin is not indicated in the early management of patients with IE.

Cited by 215 publications

References 36 publications

Major Cerebral Events in <i>Staphylococcus Aureus</i> Infective Endocarditis: Is Anticoagulant Therapy Safe?

Major Cerebral Events in <i>Staphylococcus Aureus</i> Infective Endocarditis: Is Anticoagulant Therapy Safe?

Clinical Trial Report: Is It Safe to Continue Anticoagulation Therapy in Patients with Infective Endocarditis?

Die infektiöse Endokarditis bei Intensivpatienten

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