Prediction of Hemorrhagic Transformation Following Embolic Stroke in Patients with Prosthetic Valve Endocarditis
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Hemorrhagic transformation (HT) of stroke is a disastrous complication in patients with infective endocarditis (IE). In patients with mechanical heart valves complicated by IE, physicians struggle with the appropriateness of anticoagulation administration given the risk of thromboembolism and HT of stroke. In this study, we aimed to define predictive parameters of HT of stroke in patients with prosthetic valve endocarditis (PVE). Methods: This study was a multicenter, retrospective design. We recruited from 7 institutions a total of 111 patients diagnosed with PVE during May, 2011 to April, 2012. Results: Complication of stroke was seen in 26/111 patients (23%), and HT of stroke was seen in 11/111 patients (10%). Most patients with HT (9/11, 82%) had supratherapeutic prothrombin times. However, there were no significant differences in clinical and laboratory values between PVE patients without stroke and those patients who had a stroke and with or without concurrent HT. Furthermore, echocardiographic parameters also did not show significant between-group differences. Conclusion: Even though this was a multicenter study, a limited number of patients was identified and may explain the negative results seen here. However, a large number of PVE patients with stroke also developed HT. Therefore, further studies to define predictive parameters of HT should be implemented in a larger population.
Abstract
Background: Hemorrhagic transformation (HT) of stroke is a disastrous complication in patients with infective endocarditis (IE). In patients with mechanical heart valves complicated by IE, physicians struggle with the appropriateness of anticoagulation administration given the risk of thromboembolism and HT of stroke. In this study, we aimed to define predictive parameters of HT of stroke in patients with prosthetic valve endocarditis (PVE). Methods: This study was a multicenter, retrospective design. We recruited from 7 institutions a total of 111 patients diagnosed with PVE during May, 2011 to April, 2012. Results: Complication of stroke was seen in 26/111 patients (23%), and HT of stroke was seen in 11/111 patients (10%). Most patients with HT (9/11, 82%) had supratherapeutic prothrombin times. However, there were no significant differences in clinical and laboratory values between PVE patients without stroke and those patients who had a stroke and with or without concurrent HT. Furthermore, echocardiographic parameters also did not show significant between-group differences. Conclusion: Even though this was a multicenter study, a limited number of patients was identified and may explain the negative results seen here. However, a large number of PVE patients with stroke also developed HT. Therefore, further studies to define predictive parameters of HT should be implemented in a larger population.
참고문헌 (19)
- Baddour LM, "Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia; American Heart Association; Infectious Diseases Society of America. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America", Circulation, 111, pp.e394~e434 (2005)
- Okada Y, "Hemorrhagic transformation in cerebral embolism", Stroke, 20, pp.598~603 (1989)
- Adams HP Jr, "American Heart Association; American Stroke Association Stroke Council; Clinical Cardiology Council; Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association", American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists, 2007, pp.38, 1655~1711
- Lodder J, "Cerebral hemorrhagic infarction at autopsy: cardiac embolic cause and the relationship to the cause of death", Stroke, 17, pp.626~629 (1986)
- Hallevi H, "Escobar MA, Gonzales NR, Noser EA, Illoh K, Grotta JC. Anticoagulation after cardioembolic stroke: to bridge or not to bridge?", Arch Neurol, 65, pp.1169~1173 (2008)
- Aviv RI, "Hemorrhagic transformation of ischemic stroke: prediction with CT perfusion", Radiology, 250, pp.867~877 (2009)
- Salem DN, "Antithrombotic therapy in valvular heart disease", Chest, 119(1 Suppl), pp.207S~219S (2001)
- Davenport J, "Prosthetic valve endocarditis 1976-1987. Antibiotics, anticoagulation, and stroke", Stroke, 21, pp.993~999 (1990)
- Piechowski-Jóźwiak B, "Infectious endocarditis and stroke: any lessons learned since William Osler’s Gulstonian lectures?", Neurology, 61, pp.1324~1325 (2003)
- Ulrich JN, "Single- vessel versus multivessel territory acute ischemic stroke: value of transesophageal echocardiography in the differentiation of embolic stroke", J Am Soc Echocardiogr, 19, pp.1165~1169 (2006)
- Fiorelli M, "Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort", Stroke, 30, pp.2280~2284 (1999)
- Ruttmann E, "Neurological outcome of septic cardioembolic stroke after infective endocarditis", Stroke, 37, pp.2094~2099 (2006)
- Paciaroni M, "Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials", Stroke, 38, pp.423~430 (2007)
- Durack DT, "New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service", Am J Med, 96, pp.200~209 (1994)
- Anguera I, "Aorto-cavitary Fistula in Endocarditis Working Group. Aorto-cavitary fistulous tract formation in infective endocardi tis: clinical and echocardiographic features of 76 cases and risk factors for mortality", Eur Heart J, 26, pp.288~297 (2005)
- Sanfilippo AJ, "Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications", J Am Coll Cardiol, 18, pp.1191~1199 (1991)
- Derex L, "Impact of stroke on therapeutic decision making in infective endocarditis", J Neurol, 257, pp.315~321 (2010)
- Røder BL, "Neurologic manifestations in Staphylococcus aureus endocarditis: a review of 260 bacteremic cases in nondrug addicts", Am J Med, 102, pp.379~386 (1997)
- Tornos P, "Infective endocarditis due to Staphylococcus aureus: deleterious effect of anticoagulant therapy", Arch Intern Med, 159, pp.473~475 (1999)