Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

U. Snygg-Martin (1, 2) , R. V. Rasmussen (3) , C. Hassager (4) , N. E. Bruun (3) , R. Andersson (1, 5) , L. Olaison (1)

1 Department of Infectious Diseases, Institute of Biomedicine
2 Department of Infectious Diseases, Institute of Biomedicine
3 Department of Cardiology
4 Department of Cardiology, Rigshospitalet
5 Research and Development Centre

Anticoagulant therapy has been anticipated to increase the risk of cerebrovascular complications (CVC) in native valve endocarditis (NVE). This study investigates the relationship between ongoing oral anticoagulant therapy and the incidence of symptomatic CVC in left-sided NVE. In a prospective cohort study, the CVC incidence was compared between NVE patients with and without ongoing warfarin. Among 587 NVE episodes, 48 (8%) occurred in patients on warfarin. A symptomatic CVC was seen in 144 (25%) patients, with only three on warfarin. CVC were significantly less frequent in patients on warfarin (6% vs. 26%, odds ratio [OR] 0.20, 95% confidence interval [CI] 0.06-0.6,  = 0.006). No increase in haemorrhagic lesions was detected in patients on warfarin. aetiology (adjusted OR [aOR] 6.3, 95% CI 3.8-10.4) and vegetation length (aOR 1.04, 96% CI 1.01-1.07) were risk factors for CVC, while warfarin on admission (aOR 0.26, 95% CI 0.07-0.94), history of congestive heart failure (adjusted OR 0.22, 95% CI 0.1-0.52) and previous endocarditis (aOR 0.1, 95% CI 0.01-0.79) correlated with lower CVC frequency.

Mots clés: Life Sciences

U. Snygg-Martin, R. V. Rasmussen, C. Hassager, N. E. Bruun, R. Andersson, et al.. Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis. European Journal of Clinical Microbiology and Infectious Diseases, 2010, 30 (2), pp.151-157. ⟨10.1007/s10096-010-1063-3⟩. ⟨hal-00625146⟩