Both aspirin and statin therapy reduce embolic events in patients with infective endocarditis

Abstract

Embolic events (EE) are major complications of infective endocarditis (IE). Animal models have demonstrated the benefit of aspirin (ASP) and statins (ST) in their prevention, but clinical studies have given conflicting results. To evaluate the benefit of prior ASP or ST therapy on embolic risk in patients with IE. In a retrospective study from 2010 to 2016, the impact of daily ASP or ST therapy on admission on the risk of EE in patients with IE was assessed. The primary end point was EE occurring before or during hospitalization. Among 529 pts with IE, 135 (25%) were treated by ASP, 130 (24%) were treated by ST at the time of diagnosis. EE occurred in 264 (50%) pts including 242 (46%) before and 61 (11%) after initiation of antibiotics. As compared with the 394 pts without prior ASP therapy, the 135 ASP pts were older (67.8 ± 11 vs. 64.4 ± 16 P = 0.02), had more frequent history of renal failure ( P = 0.0008) and presented with less frequent EE [53 (39%) vs. 211 (53%) P = 0.01] and similar hemorrhagic complications (8 (5.9%) vs. 45 (11%) P = NS). As compared with the 399 patients without previous ST therapy, the 130 ST patients were older (63.6 ± 16 vs. 70.2 ± 9 P < 0.0005), had more frequent history of diabetes, hypertension, and atrial fibrillation, and presented with less frequent EE [55 (42%) vs. 209 (52%) P = 0.04] and similar hemorrhagic complications (9 (7%) vs. 44 (11%) P = NS). Factors associated with increased EE were IVDA (OR 2.68 [1.45; 5.22]), vegetation length (OR 1.07 [1.05; 1.09]), and staphylococcus aureus (OR 1.51 [1.05; 2.18]), while ASP (OR 0.56 [0.38; 0.83]), and ST (OR 0.67 [0.45; 0.99] were protective. By multivariate analysis, only ASP (OR 0.6 [0.4; 0.92]) was protective against EE. Prior aspirin and statin therapy reduces EE in patients with IE without increasing hemorrhagic risk. Additional prospective studies are warranted to assess the benefit of both therapies in reducing morbidity and mortality in IE.