Antithrombotic Therapy in Patients With Infective Endocarditis : A Systematic Review and Meta-Analysis

GND
1242046895
Affiliation
Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena
Caldonazo, Tulio;
GND
1244837601
Affiliation
Department of Neurology, Friedrich-Schiller-University, Jena
Musleh, Rita;
Affiliation
Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg
Moschovas, Alexandros;
GND
1180648404
Affiliation
Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena
Kirov, Hristo;
GND
133832325
Affiliation
Department of Cardiology, Friedrich-Schiller-University, Jena
Franz, Marcus;
Affiliation
Department of Neurology, University Hospital of Würzburg (UKW), Würzburg
Haeusler, Karl Georg;
GND
128690275
Affiliation
Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena
Faerber, Gloria;
GND
120602571
Affiliation
Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena
Doenst, Torsten;
GND
122008146
Affiliation
Department of Neurology, Friedrich-Schiller-University, Jena
Günther, Albrecht;
GND
1062970365
Affiliation
Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena
Diab, Mahmoud

BACKGROUND: Antithrombotic therapy (ATT) in patients with infective endocarditis (IE) is challenging.

OBJECTIVES: The authors evaluated the impact of anticoagulant and antiplatelet therapy on clinical endpoints in IE patients.

METHODS: We performed a systematic review and meta-analysis comparing IE patients with prior and/or ongoing use of ATT vs those without any ATT during IE course. Primary outcome was reported in-hospital cerebrovascular events. Secondary outcomes were in-hospital mortality, intracranial hemorrhage (ICH), systemic thromboembolism (ST), and mortality within 6 months.

RESULTS: Twelve studies, with a total of 12,151 patients, were included. The primary endpoint was not different comparing 10,115 IE patients with or without prior anticoagulation (OR: 1.10; 95% CI: 0.56-2.17; P ¼ 0.77) or comparing 838 IE patients with or without prior antiplatelet (OR: 0.90; 95% CI: 0.61-1.33; P ¼ 0.61). In-hospital mortality was lower in IE patients with prior anticoagulation compared to those without (OR: 0.74; 95% CI: 0.57-0.96; P ¼ 0.03). There was no difference in reported ICH rates between patients with or without prior anticoagulation (OR: 0.54; 95% CI:
0.27-1.09; P ¼ 0.09) or between patients with or without prior antiplatelet (OR: 0.35; 95% CI: 0.11-1.10; P ¼ 0.07). The rate of ST was lower in IE patients with prior antiplatelet therapy compared to those without (OR: 0.53; 95% CI: 0.38-0.72; P < 0.01).

CONCLUSIONS: ATT in IE patients was not associated with higher frequency of cerebrovascular events or ICH. Moreover, we found that the use of anticoagulation was associated with decreased in-hospital mortality and the use of antiplatelets was associated with decreased ST. Due to the limitations of this study, these results should be interpreted cautiously showing the necessity of a randomized setup.

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