Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?

TY - JOUR

T1 - Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?

AU - Rasmussen, Rasmus V

AU - Snygg-Martin, Ulrika

AU - Olaison, Lars

AU - Buchholtz, Kristine

AU - Larsen, Carsten T

AU - Hassager, Christian

AU - Bruun, Niels E

N1 - Keywords: Aged; Aged, 80 and over; Anticoagulants; Central Nervous System Infections; Cerebral Hemorrhage; Denmark; Echocardiography; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Stroke; Sweden

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

U2 - 10.1159/000235579

DO - 10.1159/000235579

M3 - Journal article

C2 - 19690411

SN - 0008-6312

VL - 114

SP - 284

EP - 291

JO - Cardiologia

JF - Cardiologia

IS - 4

ER -