Anticoagulant Use in IE

There are NO recommendations to initiate antiplatelet or anticoagulant therapy based on the diagnosis of IE alone

CNS embolization (both clinical and subclinical) is very common in Lt sided IE, and anticoagulation may increase the risk of CNS hemorrhage

If anticoagulation/antiplatelet are indicated for other reasons, the clinician must weigh the risk of thromboembolic events versus CNS bleeding

Risk assessment should include imaging of the CNS to evaluate for any ischemic or hemorrhagic stroke even in the absence of symptoms

Generally anticoagulant therapy should be switched to unfractionated heparin to allow for early reversal if any signs of bleeding emerge

Thrombolytic therapy should NOT be administered to a patient with known IE who develops an ischemic stroke

The main focus of efforts to prevent systemic embolism are timely antimicrobial therapy and when appropriate, surgical intervention