PDF(Pubmed)
Abstract：
UNASSIGNED: Antithrombotic therapy (ATT) in patients with infective endocarditis (IE) is challenging.
UNASSIGNED: The authors evaluated the impact of anticoagulant and antiplatelet therapy on clinical endpoints in IE patients.
UNASSIGNED: We performed a systematic review and meta-analysis comparing IE patients with prior and/or ongoing use of ATT vs those without any ATT during IE course. Primary outcome was reported in-hospital cerebrovascular events. Secondary outcomes were in-hospital mortality, intracranial hemorrhage (ICH), systemic thromboembolism (ST), and mortality within 6 months.
UNASSIGNED: Twelve studies, with a total of 12,151 patients, were included. The primary endpoint was not different comparing 10,115 IE patients with or without prior anticoagulation (OR: 1.10; 95% CI: 0.56-2.17; P = 0.77) or comparing 838 IE patients with or without prior antiplatelet (OR: 0.90; 95% CI: 0.61-1.33; P = 0.61). In-hospital mortality was lower in IE patients with prior anticoagulation compared to those without (OR: 0.74; 95% CI: 0.57-0.96; P = 0.03). There was no difference in reported ICH rates between patients with or without prior anticoagulation (OR: 0.54; 95% CI: 0.27-1.09; P = 0.09) or between patients with or without prior antiplatelet (OR: 0.35; 95% CI: 0.11-1.10; P = 0.07). The rate of ST was lower in IE patients with prior antiplatelet therapy compared to those without (OR: 0.53; 95% CI: 0.38-0.72; P < 0.01).
UNASSIGNED: ATT in IE patients was not associated with higher frequency of cerebrovascular events or ICH. Moreover, we found that the use of anticoagulation was associated with decreased in-hospital mortality and the use of antiplatelets was associated with decreased ST. Due to the limitations of this study, these results should be interpreted cautiously showing the necessity of a randomized setup.
UNASSIGNED: The authors evaluated the impact of anticoagulant and antiplatelet therapy on clinical endpoints in IE patients.
UNASSIGNED: We performed a systematic review and meta-analysis comparing IE patients with prior and/or ongoing use of ATT vs those without any ATT during IE course. Primary outcome was reported in-hospital cerebrovascular events. Secondary outcomes were in-hospital mortality, intracranial hemorrhage (ICH), systemic thromboembolism (ST), and mortality within 6 months.
UNASSIGNED: Twelve studies, with a total of 12,151 patients, were included. The primary endpoint was not different comparing 10,115 IE patients with or without prior anticoagulation (OR: 1.10; 95% CI: 0.56-2.17; P = 0.77) or comparing 838 IE patients with or without prior antiplatelet (OR: 0.90; 95% CI: 0.61-1.33; P = 0.61). In-hospital mortality was lower in IE patients with prior anticoagulation compared to those without (OR: 0.74; 95% CI: 0.57-0.96; P = 0.03). There was no difference in reported ICH rates between patients with or without prior anticoagulation (OR: 0.54; 95% CI: 0.27-1.09; P = 0.09) or between patients with or without prior antiplatelet (OR: 0.35; 95% CI: 0.11-1.10; P = 0.07). The rate of ST was lower in IE patients with prior antiplatelet therapy compared to those without (OR: 0.53; 95% CI: 0.38-0.72; P < 0.01).
UNASSIGNED: ATT in IE patients was not associated with higher frequency of cerebrovascular events or ICH. Moreover, we found that the use of anticoagulation was associated with decreased in-hospital mortality and the use of antiplatelets was associated with decreased ST. Due to the limitations of this study, these results should be interpreted cautiously showing the necessity of a randomized setup.
摘要：
■感染性心内膜炎（IE）患者的抗血栓治疗（ATT）具有挑战性。
■作者评估了抗凝血剂和抗血小板治疗对IE患者临床终点的影响。
■我们进行了系统评价和荟萃分析，比较了在IE过程中先前和/或持续使用ATT的IE患者与未使用ATT的患者。主要结果为报告的院内脑血管事件。次要结果是院内死亡率，颅内出血（ICH），全身性血栓栓塞（ST），6个月内死亡率。
■12项研究，共有12151名患者，包括在内。与10,115例接受或未接受抗凝治疗的IE患者相比（OR：1.10;95％CI：0.56-2.17;P=0.77）或与838例接受或未接受抗血小板治疗的IE患者相比，主要终点没有差异（OR：0.90;95％CI：0.61-1.33;P=0.61）。与没有抗凝治疗的IE患者相比，既往抗凝治疗的IE患者的住院死亡率较低（OR：0.74；95％CI：0.57-0.96；P=0.03）。既往有或没有抗凝治疗的患者(OR:0.54;95%CI:0.27-1.09;P=0.09)或既往有或没有抗血小板治疗的患者(OR:0.35;95%CI:0.11-1.10;P=0.07)之间报告的ICH率无差异。与未接受抗血小板治疗的IE患者相比，既往接受抗血小板治疗的IE患者的ST发生率较低（OR：0.53；95％CI：0.38-0.72；P<0.01）。
■IE患者的ATT与脑血管事件或ICH的较高频率无关。此外，我们发现抗凝治疗与住院死亡率降低相关,抗血小板治疗与ST降低相关.由于本研究的局限性,这些结果应谨慎解释,表明随机化设置的必要性.
■作者评估了抗凝血剂和抗血小板治疗对IE患者临床终点的影响。
■我们进行了系统评价和荟萃分析，比较了在IE过程中先前和/或持续使用ATT的IE患者与未使用ATT的患者。主要结果为报告的院内脑血管事件。次要结果是院内死亡率，颅内出血（ICH），全身性血栓栓塞（ST），6个月内死亡率。
■12项研究，共有12151名患者，包括在内。与10,115例接受或未接受抗凝治疗的IE患者相比（OR：1.10;95％CI：0.56-2.17;P=0.77）或与838例接受或未接受抗血小板治疗的IE患者相比，主要终点没有差异（OR：0.90;95％CI：0.61-1.33;P=0.61）。与没有抗凝治疗的IE患者相比，既往抗凝治疗的IE患者的住院死亡率较低（OR：0.74；95％CI：0.57-0.96；P=0.03）。既往有或没有抗凝治疗的患者(OR:0.54;95%CI:0.27-1.09;P=0.09)或既往有或没有抗血小板治疗的患者(OR:0.35;95%CI:0.11-1.10;P=0.07)之间报告的ICH率无差异。与未接受抗血小板治疗的IE患者相比，既往接受抗血小板治疗的IE患者的ST发生率较低（OR：0.53；95％CI：0.38-0.72；P<0.01）。
■IE患者的ATT与脑血管事件或ICH的较高频率无关。此外，我们发现抗凝治疗与住院死亡率降低相关,抗血小板治疗与ST降低相关.由于本研究的局限性,这些结果应谨慎解释,表明随机化设置的必要性.
