Impact of Prior Antiplatelet Therapy on Risk of Embolism in Infective Endocarditis

Anavekar, Nandan S.; Tleyjeh, Imad M.; Anavekar, Nagesh S.; Mirzoyev, Zaur; Steckelberg, James M.; Haddad, Christopher; Khandaker, Masud H.; Wilson, Walter R.; Chandrasekaran, Krishnaswamy; Baddour, Larry M.

doi:10.1086/513197

Cited by 124 publications

(83 citation statements)

References 45 publications

(48 reference statements)

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“…Prospective and retrospective studies of adult patients report conflicting results on the role of aspirin therapy in preventing cerebral embolic events. These may reflect differences in dosing and duration of therapy [14,15]. Two patients in our series were placed on aspirin therapy at doses of 3-5 mg/kg/day with no adverse cerebral events.…”

Section: Discussionmentioning

confidence: 92%

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Venkatesan

Wainwright

2008

Pediatric Neurology

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The approach to the acute management of stroke in children with infective endocarditis is limited by the paucity of published data on their clinical course and outcome. We conducted a retrospective study at an urban tertiary care academic center to characterize the clinical course of seven pediatric patients with endocarditis and subsequent cerebral infarct. Among 115 patients with endocarditis, a stroke occurred in seven. Four patients had congenital heart disease. In 6 patients, the stroke was in the distribution of the middle cerebral artery and there was no preference for left or right hemisphere. The most common presenting symptom was focal weakness. Three patients had mycotic aneurysms, all of which were successfully repaired. Two patients were placed on aspirin therapy with no adverse effects. All patients survived but neurological recovery was variable. The two youngest patients (3 and 14 weeks of age) had the longest periods of hospitalization and had the most severe neurologic impairment. These findings suggest that children may have better outcome than adults after stroke secondary to bacterial endocarditis. Routine surveillance for mycotic aneurysms in patients with new neurological deficits and the use of aspirin should be considered in the medical management.

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Section: Discussionmentioning

confidence: 92%

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Venkatesan

Wainwright

2008

Pediatric Neurology

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“…None of our patients had prosthetic heart valves. We also excluded those being treated with platelet-inhibitors since a previous study reported reduced risk of symptomatic emboli associated with IE in patients who received continuous daily antiplatelet therapy before onset of IE [33].…”

Section: Discussionmentioning

confidence: 99%

Increased mean platelet volume in patients with infective endocarditis and embolic events

et al. 2015

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Background: Platelet activation appears to play an important role in thromboembolic complications of infective endocarditis (IE). Mean platelet volume (MPV) is subjects (10.62 ± 1.13 vs. 9.25 ± 0.97 and 8.93 ± 0.82 fL, p < 0.001, respectively). Similarly, the patients with embolic events had increased PDW compared to the non-embolic ones and the control group (16.31 ± 2.42 vs. 14.35 ± 1.97 and 14.04 ± 1.82%, p < 0.001, respectively (Cardiol J 2015; 22, 1: 37-43)

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“…No benefi ts from anticoagulation were demonstrated once antimicrobial therapy was begun. Similarly, Anavekar et al 14 showed that embolic events occurred signifi cantly less often in those who were currently on continuous daily antiplatelet therapy, suggesting that receiving antiplatelet agents at baseline protects against cardioembolic events in patients who develop infective endocarditis. However, the only randomized trial examining the initiation of antiplatelet therapy in patients diagnosed with infectious endocarditis receiving antibiotic treatment showed that adding aspirin did not reduce the risk of embolic events and was associated with a trend toward increased risk of bleeding.…”

Section: ■ Available Evidence Is Scarce and Mixedmentioning

confidence: 96%

Can patients with infectious endocarditis be safely anticoagulated?

Randhawa

Pile

Gomes

2016

CCJM

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Impact of Prior Antiplatelet Therapy on Risk of Embolism in Infective Endocarditis

Abstract: The risk of symptomatic emboli associated with IE was reduced in patients who received continuous daily antiplatelet therapy before onset of IE.

Cited by 124 publications

References 45 publications

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

Increased mean platelet volume in patients with infective endocarditis and embolic events

Can patients with infectious endocarditis be safely anticoagulated?

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