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Long-term risk of hemorrhagic stroke in patients with infective endocarditis: a Danish nationwide cohort study.

Klein, Christine F; Gørtz, Sanne; Wohlfahrt, Jan; Munch, Tina N; Melbye, Mads; Bundgaard, Henning; Iversen, Kasper K.
Clin Infect Dis; 2018 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-29920590


The present study aimed to investigate the long-term risk of hemorrhagic stroke (HS) in patients with infective endocarditis (IE).


Using a register-based nationwide cohort of 9 million Danes, we propensity score-matched patients with left-sided IE from 1977 to mid-2015 with IE-free individuals (1:10). Follow up started one year after the IE diagnosis. Hazard ratios (HRs) for HS in IE patients compared to the matched cohort were estimated using Cox regression.


During follow-up of 5,735 IE patients with left sided IE from one year after IE diagnosis and up to 37·5 years (median 6·3 years), 103 cases of HS were observed. Compared to the matched cohort, IE patients had higher long-term risk of HS (HR 1·47; 95% confidence interval (CI) 1·20-1·80; p=0.0002). The risk of HS was particularly increased in patients within the lowest propensity score quartile (HR 2·60; 95 % CI 1·89-3·58). Mediation analyses suggested that the increased HS risk could be explained by an indirect effect of insertion of a mechanical heart valve, atrial fibrillation or treatment with anticoagulants. The cumulative risk of HS 30 years after start of follow-up was 3·0 % in IE patients.


IE does not directly increase the long-term risk of HS. The apparent excess risk of HS in patients with previous IE was explained by mediating factors; mechanical heart valve insertion, atrial fibrillation and anticoagulation medication.
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