C-57 | Outcomes Of Antithrombotic Therapy in Patients with Infective Endocarditis: A Meta-Analysis

The decision to continue antithrombotic therapy (AT) in patients with Infective endocarditis (IE) is often challenging, particularly in those with elevated cardioembolic risk factors such as valvular atrial fibrillation, pulmonary embolism, mechanical prosthetic heart valves, and deep vein thrombosis due to concern of perpetuating extracardiac complications. We conducted a meta-analysis comparing adverse outcomes in patients with IE who received AT compared to those who did not. We searched multiple databases for studies comparing outcomes of AT therapy in IE. Outcomes assessed were major bleeding, cerebral hemorrhage, and cerebrovascular events. Pooled natural logarithm of the odds ratio (log OR) of the 95% confidence intervals were calculated for the respective outcomes measured in R studio. In outcomes where substantial heterogeneity was noted, a random effects model was used instead. A total of 6 studies were identified encompassing 1 randomized controlled trial, 1 prospective cohort study, and 4 retrospective cohort studies.There were significantly higher odds of major bleeding (log OR = 0.94; 95% CI 0.48 - 1.40) and cerebral hemorrhage (log OR = 0.94; 95% CI 0.04 - 1.84) in IE patients who received AT compared to those who did not. Cerebrovascular complications were similar between both groups (log OR = -0.11; 95% CI -1.87 - 1.65). Continuing AT in IE patients is associated with an increased risk of major bleeding and cerebral hemorrhage, with similar odds of cerebrovascular complications noted compared to IE patients not receiving AT. Further studies are needed to confirm our findings.