TOPLINE:

In patients with left-sided infective endocarditis, the use of anticoagulation therapy at diagnosis was associated with a nearly twofold higher risk for intracranial hemorrhage at 30 days, and combined anticoagulation and antiplatelet therapy was associated with a more than threefold increased risk compared with no antithrombotic therapy.

METHODOLOGY:

• Researchers conducted a prospective cohort study to assess whether the use of chronic antithrombotic therapy at diagnosis was associated with the risk for intracranial hemorrhage and other clinical outcomes in patients with definite left-sided infective endocarditis.
• They included 3236 patients from 38 centers (median age, 69 years; 68.1% men) and classified them according to the type of antithrombotic therapy received at diagnosis: no therapy (n = 1567), antiplatelet therapy (n = 664), anticoagulation (n = 868), or combined anticoagulation and antiplatelet therapy (n = 137).
• The primary endpoint was the occurrence of intracranial hemorrhage at 30 days, defined as any parenchymal, subarachnoid, or intraventricular bleeding confirmed on imaging.
• Secondary outcomes were 30-day and 1-year all-cause mortality, ischemic stroke, extracranial embolism, noncentral nervous system bleeding, and length of hospital stay.
• Patients were followed for 1 year or until death.

TAKEAWAY:

• Overall, 5.6% of patients experienced intracranial hemorrhage at 30 days; the incidence rate was highest in the combined anticoagulation and antiplatelet therapy group. The use of anticoagulation was linked to a nearly twofold higher risk for intracranial hemorrhage than no therapy (adjusted risk ratio [aRR], 1.86; 95% CI, 1.16-2.98).
• The use of combined anticoagulation and antiplatelet therapy conferred a more than threefold increased risk for intracranial hemorrhage at 30 days (aRR, 3.57; 95% CI, 1.66-7.66) and was associated with an increased risk for 1-year all-cause mortality.
• Rates of ischemic stroke, extracranial embolism, and noncentral nervous system bleeding and the length of hospital stay did not differ meaningfully among groups.
• Independent factors associated with a higher risk for intracranial hemorrhage were Staphylococcus aureus and Candida species infections, extracranial embolism, prior cerebrovascular disease, and septic shock.

IN PRACTICE:

“These results may improve understanding of how antithrombotic therapy influences prognosis and inform the multidisciplinary approach led by ID [infectious diseases] specialists,” the authors wrote.

SOURCE:

This study was led by Javier T. Solera, Instituto de Investigación Biomédica imas12, Madrid, Spain. It was published online on February 6, 2026, in Clinical Infectious Diseases.

LIMITATIONS:

The observational nature of the study precluded establishing causal relationships, and potential confounding likely remained despite statistical adjustments. Antithrombotic therapy was recorded only at diagnosis, and the analysis did not incorporate in-hospital modifications. The nonrandomized design introduced selection bias because patients on anticoagulation more often had prosthetic valves. 

DISCLOSURES:

This study received no specific funding from any public, commercial, or nonprofit organization. Several authors disclosed industry ties including support for attending conferences, honoraria for lectures, travel support, and service in scientific advisory roles with multiple pharmaceutical companies and other organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.