Anticoagulation in Patients With Stroke With Infective Endocarditis Is Safe

The Case:A 33-year-old man with a prosthetic mitral valve presents with an occipital infarct, fever, and leukocytosis. Work-up confirms the diagnosis of infective endocarditis due to Staphylococcus aureus. Cardiovascular surgeons recommend anticoagulation and urgent valve replacement. The Questions: The Controversy:The use of anticoagulation in stroke patients with infective endocarditis.Anticoagulation is a controversial issue in Staphylococcus aureus infective endocarditis (IE) because these patients are believed to be particularly susceptible to hemorrhagic transformation of embolic lesions. However, the evidence supporting the deleterious effect of anticoagulation is at best incomplete and the adverse effect of such treatment has been questioned by most recent research. An increasing number of patients with IE receive anticoagulant treatment because of mechanical prosthetic valves, atrial fibrillation, pulmonary embolism, and factor V Leiden mutation as well as other hypercoagulability disorders. These patients carry an increased risk of thromboembolism and the decision to terminate anticoagulant treatment should therefore balance the risks …