Vanassche Thomas, Peetermans Willy E, Herregods Marie-Christine, Herijgers Paul, Verhamme Peter
Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium.
Expert Rev Cardiovasc Ther. 2011 Sep;9(9):1203-19. doi: 10.1586/erc.11.100.
Despite advances in medical and surgical treatment, infective endocarditis (IE) still carries a high risk of morbidity and mortality. One of the determinants of an adverse outcome is the presence of systemic embolization and in particular, of CNS embolization. IE vegetations consist of bacteria, platelets and inflammatory cells in a fibrin mesh. The interactions between pathogens, platelets and the coagulation system are critical to vegetation initiation and growth. This understanding has led to the study of the effect of anti-thrombotic treatment on IE vegetation formation and embolization. Although it has been demonstrated that antiplatelet and anticoagulant strategies have an impact on in vitro and animal models of IE, results from the available clinical studies are conflicting. In this article, we provide an overview of the available experimental and clinical data on anti-thrombotic treatment in IE and summarize the current guidelines. An early diagnosis, prompt empiric antibiotic treatment and a careful selection of patients who benefit from early surgical intervention remain essential in the prevention of embolic complications. In patients who have other indications for antiplatelet or anticoagulant treatment, the continuation of this treatment is deemed safe in the absence of hemorrhagic complications.
尽管在医学和外科治疗方面取得了进展，但感染性心内膜炎（IE）的发病率和死亡率仍然很高。不良结局的决定因素之一是全身栓塞的存在，尤其是中枢神经系统栓塞。IE赘生物由纤维蛋白网中的细菌、血小板和炎症细胞组成。病原体、血小板和凝血系统之间的相互作用对于赘生物的形成和生长至关重要。这种认识促使人们研究抗血栓治疗对IE赘生物形成和栓塞的影响。尽管已经证明抗血小板和抗凝策略对IE的体外和动物模型有影响，但现有临床研究的结果相互矛盾。在本文中，我们概述了IE抗血栓治疗的现有实验和临床数据，并总结了当前指南。早期诊断、及时的经验性抗生素治疗以及仔细选择受益于早期手术干预的患者对于预防栓塞并发症仍然至关重要。对于有其他抗血小板或抗凝治疗指征的患者，在没有出血并发症的情况下继续这种治疗被认为是安全的。
