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Salaun E, Touil A, Hubert S, Casalta JP, Gouriet F, Robinet-Borgomano E, Doche E, Laksiri N, Rey C, Lavoute C, Renard S, Brunel H, Casalta AC, Pradier J, Avierinos JF, Lepidi H, Camoin-Jau L, Riberi A, Raoult D, Habib G. Intracranial haemorrhage in infective endocarditis. Arch Cardiovasc Dis 2018; 111:712-721. [PMID: 29884600 DOI: 10.1016/j.acvd.2018.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/23/2018] [Accepted: 03/16/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although intracranial cerebral haemorrhage (ICH) complicating infective endocarditis (IE) is a critical clinical issue, its characteristics, impact, and prognosis remain poorly known. AIMS To assess the incidence, mechanisms, risk factors and prognosis of ICH complicating left-sided IE. METHODS In this single-centre study, 963 patients with possible or definite left-sided IE were included from January 2000 to December 2015. RESULTS Sixty-eight (7%) patients had an ICH (mean age 57±13 years; 75% male). ICH was classified into three groups according to mechanism: ruptured mycotic aneurysm (n=22; 32%); haemorrhage after ischaemic stroke (n=27; 40%); and undetermined aetiology (n=19; 28%). Five variables were independently associated with ICH: platelet count<150×109/L (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.01-5.4; P=0.049); severe valve regurgitation (OR 3.2, 95% CI 1.3-7.6; P=0.008); ischaemic stroke (OR 4.2, 95% CI 1.9-9.4; P<0.001); other symptomatic systemic embolism (OR 14.1, 95% CI 5.1-38.9; P<0.001); and presence of mycotic aneurysm (OR 100.2, 95% CI 29.2-343.7; P<0.001). Overall, 237 (24.6%) patients died within 2.3 (0.7-10.4) months of follow-up. ICH was not associated with increased mortality (P not significant). However, the 1-year mortality rate differed according to ICH mechanism: 14%, 15% and 45% in patients with ruptured mycotic aneurysm, haemorrhage after ischaemic stroke and undetermined aetiology, respectively (P=0.03). In patients with an ICH, mortality was higher in non-operated versus operated patients when cardiac surgery was indicated (P=0.005). No operated patient had neurological deterioration. CONCLUSIONS ICH is a common complication of left-sided IE. The impact on prognosis is dependent on mechanism (haemorrhage of undetermined aetiology). We observed a higher mortality rate in patients who had conservative treatment when cardiac surgery was indicated compared with in those who underwent cardiac surgery.
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Affiliation(s)
- Erwan Salaun
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France.
| | - Anissa Touil
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - Sandrine Hubert
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
| | - Jean-Paul Casalta
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
| | - Frédérique Gouriet
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
| | | | - Emilie Doche
- Neurology Department, la Timone Hospital, AP-HM, 13005 Marseille, France
| | - Nadia Laksiri
- Neurology Department, la Timone Hospital, AP-HM, 13005 Marseille, France
| | - Caroline Rey
- Neurology Department, la Timone Hospital, AP-HM, 13005 Marseille, France
| | - Cécile Lavoute
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - Sébastien Renard
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - Hervé Brunel
- Radiology Department, la Timone Hospital, AP-HM, 13005 Marseille, France
| | - Anne-Claire Casalta
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - Julie Pradier
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - Jean-François Avierinos
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France
| | - Hubert Lepidi
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
| | - Laurence Camoin-Jau
- MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France; Department of Hematology, Aix Marseille University, la Timone Hospital, AP-HM, 13005 Marseille, France
| | - Alberto Riberi
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
| | - Didier Raoult
- MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
| | - Gilbert Habib
- Cardiology Department, la Timone Hospital, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France; MEPHI, IRD, IHU-Méditerranée Infection, Aix Marseille University, AP-HM, 13005 Marseille, France
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Leblanc A, Petitpain N, Pereira O, Adssi HE, Latarche C, Gillet P, Colnat-Coulbois S. [Intracranial hemorrhage and oral anticoagulants of patients treated between 2011 and 2013 at the Nancy Regional University Hospital]. Neurochirurgie 2017; 63:302-307. [PMID: 28882608 DOI: 10.1016/j.neuchi.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/03/2017] [Accepted: 02/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To perform a descriptive analysis of intracranial hemorrhages of patients treated with an antivitamin K (fluindione, acenocoumarol or warfarin) or a direct oral anticoagulant (dabigatran, rivaroxaban or apixaban) at the Nancy Regional University Hospital. MATERIAL AND METHOD The study period was from January 2011 to December 2013 and the computerized data (Programme de Médicalisation des Systèmes d'Information) of our hospital was accessed to identify the patients. Clinical data were obtained from the patients' files. Regional healthcare system was queried for reimbursement data. RESULTS Among the 157 identified cases of intracranial hemorrhage, 153 were related to antivitamin K, primarily fluindione (n=127), and only 4 to a direct oral anticoagulant (3 dabigatran and 1 rivaroxaban). During the same period, regional data indicated that 65,345 patients had had at least one reimbursement of antivitamin K and 20,983 patients one reimbursement of an oral direct anticoagulant. In our series, the most frequent intracranial hemorrhages were subdural hematoma (chronic in 65 cases, acute in 50 cases) and intraparenchymal hemorrhage (20 cases). The global mortality rate was 20.2% but varied with the site of hemorrhage. In multivariate analysis, the two risk factors of fatal outcome were coma on admission (OR 6.2; 95%CI: 2.6-15.0) and a history of previous intracranial hemorrhage (OR 13,4; 95% CI: 1,6-114,9). CONCLUSION During the 2011-2013 period, antivitamin K, especially fluindione, was the most frequently involved anticoagulants in intracranial hemorrhages with hospitalization at our Regional University Hospital. Coma on admission and a history of previous intracranial hemorrhage were the two main risk factors for fatal outcome.
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Affiliation(s)
- A Leblanc
- Centre régional de pharmacovigilance de Lorraine, hôpital Central, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France
| | - N Petitpain
- Centre régional de pharmacovigilance de Lorraine, hôpital Central, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France.
| | - O Pereira
- Direction régionale du service médical du Nord-Est, 54000 Nancy, France
| | - H El Adssi
- Département d'information médicale, hôpital St-Julien, CHRU de Nancy, 54000 Nancy, France
| | - C Latarche
- Coordination qualité risques et vigilances, CHRU de Nancy, 54000 Nancy, France
| | - P Gillet
- Centre régional de pharmacovigilance de Lorraine, hôpital Central, CHRU de Nancy, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France
| | - S Colnat-Coulbois
- Service de neurochirurgie, hôpital Central, CHRU de Nancy, 54000 Nancy, France
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