Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

“…On the contrary, more recent studies have suggested a reduced risk of brain embolism without significant hemorrhagic complications in patients on anticoagulation [4, 5]. The authors of these studies argue that the risk of ICH related to anticoagulation has been overestimated and ACT is not associated with ICH, instead having a protective effect against embolic events in IE patients.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study also reported that the incidence of cerebrovascular complications and mortality was increased when ACT was discontinued in patients with prosthetic valve IE [3]. Moreover, some recent studies have shown that warfarin use before IE diagnosis is associated with a reduced risk of cerebral events, suggesting the effectiveness of ACT in the prevention of embolization in IE patients [4, 5]. …”

Section: Introductionmentioning

confidence: 96%

Usefulness of Anticoagulant Therapy in the Prevention of Embolic Complications in Patients with Acute Infective Endocarditis

Lee

Lim

et al. 2014

BioMed Research International

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Background. The use of anticoagulant therapy (ACT) in patients with acute infective endocarditis (IE) remains a controversial issue. Our study attempts to estimate the impact of ACT on the occurrence of embolic complications and the usefulness of ACT in the prevention of embolism in IE patients. Methods. The present authors analyzed 150 patients with left-sided IE. Embolisms including cerebrovascular events (CVE) and the use of ACT were checked at the time of admission and during hospitalization. Results. 57 patients (38.0%) experienced an embolic event. There was no significant difference in the incidence of CVE and in-hospital mortality between patients with and without warfarin use at admission, although warfarin-naïve patients were significantly more likely to have large (>1 cm) and mobile vegetation. In addition, there was no significant difference in the incidence of postadmission embolism and in-hospital death between patients with and without in-hospital ACT. On multivariate logistic regression analysis, ACT at admission was not significantly associated with a lower risk of embolism in patients with IE. Conclusions. The role of ACT in the prevention of embolism was limited in IE patients undergoing antibiotic therapy, although it seems to reduce the embolic potential of septic vegetation before treatment.

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“…[11][12][13] Snygg-Martin et al 11 and Rasmussen et al 12 found not only that cerebrovascular complications were less common in patients already on anticoagulation at the time infectious endocarditis was diagnosed, but also that no increase in the rate of hemorrhagic lesions was reported. These were all nonrandomized studies, and most of the patients in them had native valve infectious endocarditis diagnosed at an early stage.…”

Section: ■ Available Evidence Is Scarce and Mixedmentioning

confidence: 99%