Clin Infect Dis

Anticoagulation at diagnosis tied to higher intracranial hemorrhage risk in infective endocarditis

March 25, 2026

In a large prospective multicenter cohort of 3,236 patients with definite left‑sided infective endocarditis (IE), baseline anticoagulation—alone or combined with antiplatelet therapy—was independently associated with a higher 30‑day risk of intracranial hemorrhage (ICH). Overall, 182 patients (5.6%) developed ICH. Incidence was highest among those on combined antithrombotic therapy (CAT: 9.5%) and anticoagulation alone (AC: 6.8%). Compared with no therapy, anticoagulation was associated with an elevated ICH risk (adjusted risk ratio [aRR], 1.83; 95% confidence interval [CI], 1.16–2.91), with the greatest risk in CAT (aRR, 2.45; 95% CI, 1.55–3.87). Antiplatelet therapy alone showed no association. CAT also independently predicted higher 1‑year mortality (adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43). Additional independent predictors of ICH included Staphylococcus aureus or Candida endocarditis, extracranial embolism, prior cerebrovascular disease, and septic shock.

Clinical takeaway: In patients with left‑sided IE, review baseline antithrombotic therapy early—especially anticoagulation and combination regimens—and individualize decisions with a low threshold for neuroimaging and multidisciplinary input.

Source:

Solera JT, et al. (2026, February 6). Clin Infect Dis. Baseline Antithrombotic Therapy and Intracranial Hemorrhage Risk in Infective Endocarditis: A Multicenter Prospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/41643743/