Modifiers of Symptomatic Embolic Risk in Infective Endocarditis

November 2011
Mayo Clinic Proceedings;Nov2011, Vol. 86 Issue 11, p1068
Academic Journal
OBJECTIVE: To ascertain the impact of prior antiplatelet and statin therapy on symptomatic embolic events in native valve infective endocarditis (IE). PATIENTS AND METHODS: We studied a retrospective cohort of adult patients with a diagnosis of IE who presented to Mayo Clinic (Rochester, MN) from January 1, 2003, to December 31, 2006. Patients were grouped into those who received treatment before infection or controls who did not receive treatment for both antiplatelet therapy and, separately, statin therapy. Because of the retrospective study design and thus the nonrandomized treatment groups, a propensity score approach was used to account for the confounding factors that may have influenced treatment allocation. Antiplatelet therapy included aspirin, dipyridamole, clopidogrel, ticlopidine or any combination of these agents. Statin therapy included atorvastatin, simvastatin, pravastatin, lovastatin, rosuvastatin, or fluvastatin. The primary end point was a symptomatic embolic event that occurred before or during hospitalization. Multivariable logistic regression was used to assess the propensity-adjusted effects of continuous daily therapy with antiplatelet and statin agents on risk of symptomatic emboli. Likewise, Cox proportional hazards regression was used to test for an independent association with 6-month mortality for each of the treatments. RESULTS: The study cohort comprised 283 patients with native valve IE. Twenty-eight patients (24.1%) who received prior continuous antiplatelet therapy developed a symptomatic embolic event compared with 66 (39.5%) who did not receive such treatment. After adjusting for propensity to treat, the effect of antiplatelet therapy on embolic risk was not statistically significant (odds ratio, 0.71; 95% confidence interval [CI], 0.37-1.36; P=.30). Only 14 patients (18.2%) who received prior continuous statin therapy developed a symptomatic embolic event compared with 80 (39.4%) of the 203 patients who did not. After adjusting for propensity to treat with statin therapy, the benefit attributable to statins was significant (odds ratio, 0.30; 95% CI, 0.14-0.62; P=.001). The 6-month mortality rate of the entire cohort was 28% (95% CI, 23%-34%). No significant difference was found in the propensity-adjusted rate of 6-month mortality between patients who had and had not undergone prior antiplatelet therapy (P=.91) or those who had and had not undergone prior statin therapy (P=.87). CONCLUSION: The rate of symptomatic emboli associated with IE was reduced in patients who received continuous daily statin therapy before onset of IE. Despite fewer embolic events observed in patients who received antiplatelet agents, a significant association was not found after adjusting for propensity factors. A continued evaluation of these drugs and their potential impact on subsequent embolism among IE patients is warranted.


Related Articles

  • Evidence-Based Medicine.  // Clinical Advisor;Jul2010, Vol. 13 Issue 7, p73 

    The article presents research findings related to medicine in the U.S. Data on 91,140 patients from 13 randomized trials indicate that statin use may increase the risk of diabetes. A study shows that low-dose colchicine can be effective as high-dose for acute gout flare with little adverse...

  • Practice observed. Darnborough, Sally // Menopause International;Sep2012, Vol. 18 Issue 3, p116 

    The article presents a case study of a 74 year old woman who has undergone the estrogen replacement therapy (ERT) and was suffering from vaginal bleeding. Her case was investigated and was expected to have a vasovagal episode. She was advised to stop her ERT and commence antiplatelet therapy...

  • Single pill for CVD improves adherence.  // Clinical Advisor;Oct2013, Vol. 16 Issue 10, p22 

    The article focuses on a study related to adherence to medication in cardiovascular diseases (CVD). It informs that a single pill which combines fixed-doses of medicines for regulating blood pressure, maintaining cholesterol level, and aspirin improves medication adherence compared with usual...

  • Aspirin/clopidogrel withdrawal.  // Reactions Weekly;10/13/2012, Issue 1423, p11 

    The article describes the case of a 72-year-old man who experienced a transient increase in transaortic pressure gradients with heart failure symptoms following antiplatelet therapy cessation with aspirin and clopidogrel.

  • Effect of Antiplatelet Agents, Statins, and Other Drugs on Vascular Access Patency Rates. Paraskevas, Kosmas I.; Mikhailidis, Dimitri P.; Roussas, Nikolaos; Giannoukas, Athanasios D. // Angiology;Feb2012, Vol. 63 Issue 1, p5 

    The article discusses the role of antiplatelet agents, statins, anticoagulants, and other agents in maintaining vascular access patency rates (arteriovenous [AV] fistula or AV graft) in vascular access dysfunction patients. Several studies including the Dialysis Outcomes and Practice Patterns...

  • The Management of Asymptomatic Carotid Plaque Disease: Our Assumptions When We are Less Radical. Makris, Gregory C.; Nicolaides, Andrew; Geroulakos, George // Angiology;Aug2011, Vol. 62 Issue 6, p455 

    The management of asymptomatic carotid artery stenosis (CAS) has been the subject of extensive debate. Current evidence suggests that the annual risk of stroke in patients with CAS and without previous cerebrovascular symptoms is 1% which makes carotid endarterectomy unjustifiable. Conservative...

  • INTERNAL MEDICINE. Naunton, Mark // Journal of Pharmacy Practice & Research;Sep2013, Vol. 43 Issue 3, p240 

    The article presents information on several research studies on internal medicine. A study by researcher M.V. Mateos and colleagues discussed the effect of lenalidomide and dexamethasone for multiple myeloma. Another study by researcher Y. Wang and colleagues focused on dual antiplatelet therapy...

  • An ounce of prevention? Seton-Rogers, Sarah // Nature Reviews Cancer;Jun2009, Vol. 9 Issue 6, p382 

    The article presents research highlights from the field of cancer research. Two drugs that have already been approved for other means may help in the prevention of prostate cancer. Rodney Breau and colleagues at the Mayo Clinic in the U.S. found that men who take statins to lower cholesterol...

  • New tool helps with statin therapy.  // Medical Economics;9/4/2009, Vol. 86 Issue 17, p16 

    The article reports on the web-based decision-support tool developed by the North Carolina States University and Mayo Clinic researchers for statin therapy in the U.S. It states that the new tool is a computer model combined with the individual patient data which will help cardiometabolic...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics