Major cerebral events in Staphylococcus aureus 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.