Antithrombotic therapy in patients with infective endocarditis
- Thomas L Ortel, MD, PhD
Thomas L Ortel, MD, PhD
- Professor of Medicine & Pathology
- Hemostasis & Thrombosis Center, Duke University
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Management of antithrombotic therapy (anticoagulant and antiplatelet agents) in patients with infective endocarditis (IE) is challenging given the competing risks of embolism and intracerebral hemorrhage in this condition and limited evidence on the effects of therapy. Anticoagulant and antiplatelet therapy have not been shown to reduce the risk of embolism in IE. However, many patients with IE have indications for antithrombotic therapy, particularly patients with mechanical prosthetic valves. In such patients, the potential risks and benefits of antithrombotic therapy must be carefully weighed.
The use of anticoagulants and antiplatelet agents in patients with IE will be reviewed here. The treatment and complications of IE are presented separately.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- MANAGEMENT APPROACH
- Clinical settings
- - Patients without other indications for antithrombotic therapy
- - Patients with other indications for antithrombotic therapy
- Conditions commonly treated with anticoagulants
- - Prosthetic valves
- - Atrial fibrillation
- - Venous thromboembolism
- Conditions commonly treated with antiplatelet therapy
- - Coronary heart disease
- - Secondary prevention of ischemic stroke
- - Primary prevention of cardiovascular disease and cancer
- Management of antithrombotic therapy if continued
- Management of cerebral complications
- - Ischemic stroke
- - Intracerebral hemorrhage
- Role of valve surgery
- Risk of embolism in IE
- - Estimates of risk
- - Risk factors
- Risk of intracerebral hemorrhage
- Effect of antithrombotic therapy
- - Antiplatelet therapy
- - Anticoagulant therapy
- SUMMARY AND RECOMMENDATIONS