All neurologic complications occurred more often with S . a ureus infection (67%) than with viridans streptococci (22%)
In native-valve endocarditis, most (74%) ischemic strokes had occurred by the time of presentation .
Patients with infective endocarditis and ischemic stroke on presentation seldom had recurrent emboli after the infection was controlled .
A nticoagulants and surgery are not warranted to prevent recurrent stroke in these patients .
Merrill C. Kanter and Robert G. Hart . Neurologic complications of infective endocarditis . Neurology 1991;41;1015 RG Hart, JW Foster, MF Luther and MC Kanter . S troke in infective endocarditis Stroke . 1990;21;695-700
Left - sided S aureus IE (native valve 35 pt, prosthetic valve 21 pt)
Of the prosthetic valve IE, 19 (90%) were taking oral anticoagulant therapy at the time of diagnosis while no patient with native valve IE was receiving such treatment.
Mortality was higher in prosthetic valve IE than in native valve IE (71% vs 37%; P =.02). No patient with native valve IE died due to central nervous system complications, while 73% (11 of 15 patients) with prosthetic valve IE died due to central nervous system complications.
Pilar Tornos, et al. Infective Endocarditis Due to Staphylococcus aureus . Arch Intern Med . 1999;159:473-475.
In pt with native valve disease, the benefit of anticoagulation has never been demonstrated convincingly.
C ontroversial, particularly in mechanical valve endocarditis.
In contrast, some authorities recommend continuation of therapy in patients with mechanical prosthetic valve IE; however, the general advice is to discontinue all anticoagulation in patients with S aureus prosthetic valve IE who have experienced a recent central nervous system embolic event for at least the first 2 weeks of antibiotic therapy .
Until further definitive data are available, the routine use of aspirin for established endocarditis is not r ecommended (Class III, Level of Evidence: B).
Larry M. Baddour et al. Infective Endocarditis . Circulation . 2005; 111:e394-e433 .
There is no indication for the initiation of antithrombotic drugs (thrombolytic drugs, anticoagulant or antiplatelet therapy) during the active phase of IE. In patients already taking oral anticoagulants, there is a risk of intracranial haemorrhage which seems to be highest in patients with S. aureus PVE and those with a previous neurological event. The recommendations for the management of the anticoagulant therapy are based on low level of evidence .
European Society of Cardiology . Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) . European Heart Journal (2009) 30, 2369–2413