https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 2Krankenhaushygiene und Infektiologie Regensburg, Deutschland; 3Klinik für Neurologie Regensburg, Deutschland
Background: Antithrombotic therapy (ATT) in patients with infective endocarditis (IE) remains a matter of compromise. Evidence on mid- and long-term outcomes is limited. This study aims to evaluate the effect of ATT on mortality and functional neurological outcome in patients with left-sided IE.
Methods: We retrospectively analyzed data in a tertiary care hospital for IE cases over 10 years. Further, vital and neurological status (modified Ranking Scale, mRS) were assessed by a telephone follow-up. Endpoints were all-cause mortality and unfavorable neurological outcome (mRS score ≥3 out of 5 points). Survival and regression analyses were employed to estimate the effect of ATT. As ATT has changed during hospitalization for some patients, two cohorts were analyzed: the intra-hospital cohort was based on ATT at admission (adm-ATT), and the extra-hospital cohort (consisting of the same patients as the first cohort minus those who died in hospital) was based on ATT at discharge (dis-ATT).
Results: 367 consecutive patients (65 ± 13 years, 25% female) with left -sided IE were analyzed. Mean follow-up time was 4.0 ± 3.3 years. At admission, 182 patients (49.6%) received no ATT (none), 104 (28.3%) received mono or dual antiplatelet therapy (ATP), and 81 (22.1%) were on anticoagulation (AC) with or without ATP. During the hospital stay (36 ± 33 days), 74 patients died, 16.5% without adm-ATT, 23.1% with ATP, and 24.7% with AC (P = 0.212, 1-way ANOVA). 297 patients were discharged, 61 (20.8%) without ATT, 45 (15.4%) with ATP, and 188 (64.2%) with AC. Until follow-up (mean 4.0 ± 3.3 years) Kaplan-Meier survival analysis (Figures 1A and B) showed no significant difference for intra- (P = 0.549) and extra-hospital (0.077) mortality. Interestingly, Cox regression analysis revealed an influence of adm-ATT (estimate 1.70, 95% confidence interval 1.20-2.42) as well as dis-ATT (0.48, 0.37-0.67), indicating a higher intra-hospital and a lower extra-hospital mortality with ATT. See Table 1, also for other explanatory variables. Unfavorable neurological outcome occurred in 31.1% without ATT, 28.3 % with ATP and 32.3 % with AC (P = 0.920) with no explanatory effect of adm-ATT (1.38, 0.59-3.07, P = 0.433) or dis-ATT (0.64, 0.33-1.27, P = 0.169) in the Cox regression model.
Conclusion: In this retrospective analysis we were able to add evidence on the effect of ATT on mortality and neurologic outcome in patients hospitalized for left-sided IE. While there was no significant difference in survival analysis between the 3 ATT groups on intra- and extra-hospital mortality, ATT at admission was associated with an increased hazard ratio for intra-hospital mortality and a decreased hazard ratio for extra-hospital mortality. Unfavorable neurological outcome did not differ between the groups.