title: Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?
abstract: OBJECTIVE
  To study the impact of anticoagulation on major cerebral events in patients with left-sided Staphylococcus aureus infective endocarditis (IE).
  
  
  METHODS
  A prospective cohort study; the use of anticoagulation and the relation to major cerebral events was evaluated separately at onset of admission and during hospitalization.
  
  
  RESULTS
  Overall, 70 out of 175 patients (40%; 95% CI: 33-47%) experienced major cerebral events during the course of the disease, cerebral ischaemic stroke occured in 59 patients (34%; 95% CI: 27-41%), cerebral infection in 23 patients (14%; 95% CI: 9-19%), and cerebral haemorrhage in 5 patients (3%; 95% CI: 0.5-6%). Patients receiving anticoagulation were less likely to have experienced a major cerebral event at the time of admission (15%) compared with those without anticoagulation (37%, p = 0.009; adjusted OR: 0.27; 95% CI: 0.075-0.96; p = 0.04). In-hospital mortality was 23% (95% CI: 17-29%), and there was no significant difference between those with or without anticoagulation.
  
  
  CONCLUSIONS
  We found no increased risk of cerebral haemorrhage in S. aureus IE patients receiving anticoagulation. Anticoagulation was associated with a reduced risk of cerebral events before initiation of antibiotics. Data support the continuance of anticoagulation in S. aureus IE patients when indicated.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. ravera02@geh.regionh.dk
authors.forename: Rasmus V
authors.initials: RV
authors.lastname: Rasmussen
authors.forename: Ulrika
authors.initials: U
authors.lastname: Snygg-Martin
authors.forename: Lars
authors.initials: L
authors.lastname: Olaison
authors.forename: Kristine
authors.initials: K
authors.lastname: Buchholtz
authors.forename: Carsten T
authors.initials: CT
authors.lastname: Larsen
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Niels E
authors.initials: NE
authors.lastname: Bruun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D002494:Central Nervous System Infections / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000209:etiology; D003718:Denmark / Q000453:epidemiology; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D013211:Staphylococcus aureus; D020521:Stroke / Q000209:etiology*; D013548:Sweden / Q000453:epidemiology
chemical_list: D000925:Anticoagulants