Antithrombotic Therapy in Patients With Infective Endocarditis: A Systematic Review and Meta-Analysis.
JACC Adv
; 3(2): 100768, 2024 Feb.
Article
em En
| MEDLINE
| ID: mdl-38939390
ABSTRACT
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 = 0.77) or comparing 838 IE patients with or without prior antiplatelet (OR 0.90; 95% CI 0.61-1.33; P = 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 = 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 = 0.09) or between patients with or without prior antiplatelet (OR 0.35; 95% CI 0.11-1.10; P = 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
JACC Adv
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Alemanha