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

Abstract

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.

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

“…Fewer CVC among warfarin treated patients was seen for all microbiological aetiologies, but the difference was significant for episodes caused by Staphylococcus aureus only, as separately described [31]. This uniform pattern irrespective of NVE causative organism supports the results of the multivariate analysis with an independent association between warfarin use and lower CVC incidence.…”

Usefulness of Anticoagulant Therapy in the Prevention of Embolic Complications in Patients with Acute Infective 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.…”

“…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]. …”

Pulmonary Embolization with Tunneled Hemodialysis Catheter-Associated Blood Stream Infection: The Perils of Systemic Anticoagulation

“…Thrombosis in the femoral vein would, however, be expected to be different due to the femoral vein's large size and large clot load. 6 While some argument for the safety of anticoagulation with endocarditis has been made in the general population, 7 there are no such data for ESRD patients. The combination of systemic anticoagulation with heparin and acute bacterial endocarditis was, indeed, the worst possible confluence of events for this patient and likely contributed to the catastrophic intracranial bleed.…”