The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective
Objective: Antiaggregants (Ag) could prevent infective endocarditis (IE) in preclinical studies. In this study we investigated whether Ag or anticoagulants (Ac) were also protective in humans. Methods: In part I we determined the incidence of IE of bioprosthetic aortic valves (PVE) in 333 consecutiv...
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| Language: | English |
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Elsevier
2021-12-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273621003739 |
| _version_ | 1818745100670337024 |
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| author | Hanne Theys, MD Jef Van den Eynde, BSc Marie-Christine Herregods, MD, PhD Philippe Moreillon, MD, PhD Ruth Heying, MD, PhD Wouter Oosterlinck, MD, PhD |
| author_facet | Hanne Theys, MD Jef Van den Eynde, BSc Marie-Christine Herregods, MD, PhD Philippe Moreillon, MD, PhD Ruth Heying, MD, PhD Wouter Oosterlinck, MD, PhD |
| author_sort | Hanne Theys, MD |
| collection | DOAJ |
| description | Objective: Antiaggregants (Ag) could prevent infective endocarditis (IE) in preclinical studies. In this study we investigated whether Ag or anticoagulants (Ac) were also protective in humans. Methods: In part I we determined the incidence of IE of bioprosthetic aortic valves (PVE) in 333 consecutive patients who underwent aortic valve replacement for noninfective aortic insufficiency between 2009 and 2019. In part II we retrospectively analyzed data of 137 patients who had developed IE of the native aortic valve (NVE) between 2007 and 2015. Multivariable Fine–Gray and logistic regression models were used to investigate associations between Ag and Ac therapy and IE. Results: Sixteen of 333 (4.8%) aortic valve replacement recipients developed PVE after a median of 3.72 years. There was no association between Ag and PVE, whereas Ac was associated with a higher IE occurrence (no association for vitamin K antagonists but significant for fondaparinux or low molecular-weight heparins; hazard ratio, 4.61; 95% CI, 1.01-21.9). In contrast, among the 137 patients in part II, vitamin K antagonists (odds ratio [OR], 7.52; 95% CI, 2.51-22.6), double antiplatelet therapy (OR, 44.3; 95% CI, 4.83-407), novel oral Ac (OR, 4.17; 95% CI, 1.15-15.1), and fondaparinux or low molecular-weight heparins (OR, 9.87; 95% CI, 1.81-53.9), but not acetylsalicylic acid, were associated with NVE. Conclusions: Ac were associated with IE in both cohorts, whereas Ag were not associated with PVE. This might reflect differences in the studied populations, with Ag and Ac being prescribed for conditions associated with long-term IE risk in the NVE cohort. Therefore, determining the potential protective effect of Ag and Ac will necessitate further well–controlled studies. |
| first_indexed | 2024-12-18T02:54:50Z |
| format | Article |
| id | doaj.art-1f8f90dbf6a94206919d0e7e76aca773 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-12-18T02:54:50Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
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| series | JTCVS Open |
| spelling | doaj.art-1f8f90dbf6a94206919d0e7e76aca7732022-12-21T21:23:23ZengElsevierJTCVS Open2666-27362021-12-018301312The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspectiveHanne Theys, MD0Jef Van den Eynde, BSc1Marie-Christine Herregods, MD, PhD2Philippe Moreillon, MD, PhD3Ruth Heying, MD, PhD4Wouter Oosterlinck, MD, PhD5Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, BelgiumDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MdDepartment of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Fundamental Microbiology, University Lausanne, Lausanne, SwitzerlandDepartment of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Address for reprints: Wouter Oosterlinck, MD, PhD, Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.Objective: Antiaggregants (Ag) could prevent infective endocarditis (IE) in preclinical studies. In this study we investigated whether Ag or anticoagulants (Ac) were also protective in humans. Methods: In part I we determined the incidence of IE of bioprosthetic aortic valves (PVE) in 333 consecutive patients who underwent aortic valve replacement for noninfective aortic insufficiency between 2009 and 2019. In part II we retrospectively analyzed data of 137 patients who had developed IE of the native aortic valve (NVE) between 2007 and 2015. Multivariable Fine–Gray and logistic regression models were used to investigate associations between Ag and Ac therapy and IE. Results: Sixteen of 333 (4.8%) aortic valve replacement recipients developed PVE after a median of 3.72 years. There was no association between Ag and PVE, whereas Ac was associated with a higher IE occurrence (no association for vitamin K antagonists but significant for fondaparinux or low molecular-weight heparins; hazard ratio, 4.61; 95% CI, 1.01-21.9). In contrast, among the 137 patients in part II, vitamin K antagonists (odds ratio [OR], 7.52; 95% CI, 2.51-22.6), double antiplatelet therapy (OR, 44.3; 95% CI, 4.83-407), novel oral Ac (OR, 4.17; 95% CI, 1.15-15.1), and fondaparinux or low molecular-weight heparins (OR, 9.87; 95% CI, 1.81-53.9), but not acetylsalicylic acid, were associated with NVE. Conclusions: Ac were associated with IE in both cohorts, whereas Ag were not associated with PVE. This might reflect differences in the studied populations, with Ag and Ac being prescribed for conditions associated with long-term IE risk in the NVE cohort. Therefore, determining the potential protective effect of Ag and Ac will necessitate further well–controlled studies.http://www.sciencedirect.com/science/article/pii/S2666273621003739anticoagulantsaortic valvebioprosthetic valvesinfective endocarditisplatelet aggregation inhibitors |
| spellingShingle | Hanne Theys, MD Jef Van den Eynde, BSc Marie-Christine Herregods, MD, PhD Philippe Moreillon, MD, PhD Ruth Heying, MD, PhD Wouter Oosterlinck, MD, PhD The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective JTCVS Open anticoagulants aortic valve bioprosthetic valves infective endocarditis platelet aggregation inhibitors |
| title | The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective |
| title_full | The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective |
| title_fullStr | The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective |
| title_full_unstemmed | The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective |
| title_short | The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective studyCentral MessagePerspective |
| title_sort | role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis a double cohort retrospective studycentral messageperspective |
| topic | anticoagulants aortic valve bioprosthetic valves infective endocarditis platelet aggregation inhibitors |
| url | http://www.sciencedirect.com/science/article/pii/S2666273621003739 |
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