Major cerebral events in staphylococcus aureus infective endocarditis: Is anticoagulant therapy safe?

Rasmus V. Rasmussen, Ulrika Snygg-Martin, Lars Olaison, Kristine Buchholtz, Carsten T. Larsen, Christian Hassager, Niels E. Bruun

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    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.

    OriginalsprogEngelsk
    Sider (fra-til)284-291
    Antal sider8
    TidsskriftCardiology
    Vol/bind114
    Udgave nummer4
    DOI
    StatusUdgivet - 1 okt. 2009

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