title: Prosthetic valve endocarditis 1976-1987. Antibiotics, anticoagulation, and stroke.
abstract: We retrospectively reviewed the clinical characteristics and outcomes of 61 patients with 62 episodes of prosthetic valve endocarditis, paying particular attention to neurologic complications (stroke). Atypical features of the group included a benign outcome of early postoperative infection (18% mortality) and a high stroke morbidity and mortality rate with Staphylococcus epidermidis infections. Eleven patients (18%) suffered an embolic stroke, most less than or equal to 3 days after diagnosis and before the initiation of antimicrobial therapy; the rate of embolic stroke recurrence was low (9%). The risk of embolic stroke was lower with bioprosthetic than with mechanical valves. No protective effect of anticoagulation therapy with warfarin was observed. Six patients (8%) suffered brain hemorrhage due to septic arteritis, brain infarction, or undetermined causes; no specific risk of hemorrhagic stroke was evident with anticoagulation therapy. Antibiotic treatment appears to be more important than anticoagulation to prevent neurologic complications in patients with prosthetic valve endocarditis.
authors.affiliation: Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: J
authors.initials: J
authors.lastname: Davenport
authors.forename: R G
authors.initials: RG
authors.lastname: Hart
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D001705:Bioprosthesis / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D004452:Echocardiography; D004696:Endocarditis / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants