Why the study?
Does anticoagulation increase the risk of symptomatic cerebral hemorrhage and death in patients with prosthetic valve endocarditis?
Does anticoagulation increase the risk of symptomatic cerebral hemorrhage and death in patients with prosthetic valve endocarditis?
Anticoagulation in patients with prosthetic valve endocarditis is associated with a high risk of fatal central nervous system hemorrhage.
Anticoagulation in PVE warrants caution given fatal CNS hemorrhage risk; leaves open optimal strategy pending randomized trials.
We reviewed the experience with infective endocarditis at some major US Army Medical Centers. One hundred patients were studied, comparing 82 patients who had native valve endocarditis (NVE) with 18 patients who had prosthetic valve endocarditis (PVE). Among patients with PVE, four had porcine valves and 14 had synthetic. None of the patients with NVE had received anticoagulants; 14 of 18 patients with PVE had received anticoagulants. The major causes of death were central nervous system hemorrhage, congestive heart failure, uncontrolled infection, and embolic phenomena. The principal cause of death in patients with PVE was CNS hemorrhage. Of the patients with PVE, 36% had symptomatic cerebral hemorrhage while receiving anticoagulants and 80% of them died.
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CARPENTER et al. (1983) studied this question.