Association of anticoagulation with outcomes in patients with infective endocarditis

Abstract Background Infective endocarditis (IE) is a disease that is associated with high risk of morbidity and mortality. The utility of systemic anticoagulation (AC) in patients with IE has not been well defined. The purpose of this meta-analysis is to evaluated the utility of AC in patients with IE. Methods A literature search was conducted for studies reporting on the use of AC in patients with IE and clinical endpoints. The primary endpoint was all neurological complications. Secondary endpoints included all-cause mortality, ischemic cerebral vascular accident (CVA), and hemorrhagic CVA. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted by time or publication status. Results A total of 12 studies with 9,063 participants with IE (1994 on AC, 7069 not on AC) met inclusion criteria. Mean age was 58 years, 65.8% were men, 20.9% had prosthetic valves. There was no statistically significant difference in risk of neurological complications in patients on AC compared to patients not on AC (OR 0.88, 95% CI 0.68-1.12; p=0.30). There was a trend towards increased risk of all-cause mortality in patients treated with AC compared to patients not on AC (OR 1.27, 95% CI 0.99-1.63; p=0.06). Patients on AC had significantly higher risk of hemorrhagic CVA compared to patients not on AC (OR 1.51, 95% CI 1.05-2.19; p=0.03). There was no statistically significant difference in risk of ischemic CVA in patients on AC compared to patients not on AC (OR 1.10, 95% CI 0.89-1.37; p=0.37). Conclusions Use of anticoagulation in patients with infective endocarditis is not associated with reduction in risk of neurological complications and may increase risk of all-cause mortality and hemorrhagic CVA. Further high quality studies are required to further characterize the use of anticoagulation in this disease process.