Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Cerebrovascular accidents in infective endocarditis: role of anticoagulation
Department of Cardiology, Hopital Cardiologique 69394 Lyon Cedex 03, France
Received 16 October 1989; revised 2 October 1990; .
Address for reprints: Jean Pierre Dclabaye, MD, Department of Cardiology, Hopital Cardiologique, 69394 Lyon Cedex 03, France.
Abstract
Anticoagulation is still a matter of debate in infective endocarditis, since it can increase the risk of complications, mostly neurological. In our series of 269 patients with native valve endocarditis studied between 1970 and 1982, 35 were anticoagulated. We observed 14 patients with brain infarcts, of whom five died, and 12 patients with cerebromeningeal or brain haemorrhage of whom six died. In a similar series of 63 patients with prosthetic valve endocarditis, all of whom were on anticoagulation and were studied between 1972 and 1987, we observed five patients with brain infarcts, three of whom died, and two patients with brain haemorrhage, one of whom died. The frequency of cerebrovascular accident (CVA) was similar for both groups (111% in prosthetic endocarditis vs 11.5% in native valve endocarditis, P = ns), as was mortality rate (57% vs 48–4%, P = ns). CVA are significantly more frequent among anticoagulated patients (19/94 vs 19/238: P<0.01), but the mortality rate in CVA is similar for anticoagulated and non-ant icoagulated patients (11/19 vs 8/19: P = ns). The indications for anticoagulation in infective endocarditis remain similar to those in valvular heart disease. In patients with infective endocarditis, anticoagulation with heparin should be maintained whenever a brain infarct is present, unless it is large and/or haemorrhagic.
Key Words: Infective endocarditis • cerebrovascular accident • anticoagulation
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