Does the use of anticoagulation or antiplatelet therapy increase cerebrovascular events in patients with infective endocarditis - a systematic review and meta-analysis

Abstract

Abstract Background Management of anticoagulant and antiplatelet therapy in patients with infective endocarditis (IE) remains challenging. We aimed to evaluate the impact of antiplatelet and anticoagulant therapy on cerebrovascular events (CVE) and mortality in IE-patients. Methods Assessing three databases (MEDLINE, EMBASE, and Cochrane Library), we performed a systematic review and meta-analysis of studies comparing patients with prior and/or ongoing use of antithrombotic therapy (anticoagulation or antiplatelet) versus those without any antithrombotic therapy during IE course. Primary outcome was CVE. Secondary outcomes were perioperative and mid-term (>6 months) mortality, intracranial hemorrhage (ICH), and systemic thromboembolism. Inverse variance method was performed. Results Twelve studies with a total of 11,960 patients were included. The primary endpoint (CVE) was not different between the anticoagulation or the antiplatelet group and the control group. Perioperative mortality was lower in the anticoagulation group compared to the control group (OR= 0.74, 0.57-0.96, p=0.03). There was no significant difference in the incidence of ICH between the anticoagulation or antiplatelet group and the control group. Conclusion The results suggest that the prior and/or ongoing use of anticoagulants or antiplatelets in patients with IE was associated with similar rates of CVE in general and of ICH in particular. Lack of information about the indications for stopping or continuing antithrombotic therapy in the majority of the included studies is a limitation of this meta-analysis, showing the necessity of a randomized setup.