Heart and Vessels

, Volume 6, Issue 2, pp 102–106 | Cite as

Hemostatic studies in patients with infective endocarditis: a report on nine consecutive cases with evidence of coagulopathy

  • Taha H. Taha
  • Simon Durrant
  • Jonathan Crick
  • Stella Bowcock
  • Anne Bradshaw
  • Celia M. Oakley


Local and generalized changes in coagulation may be important in the genesis of vegetations and embolism in infective endocarditis. To characterize such alterations, serial hematological investigations were performed on nine consecutive patients who satisfied the inclusion criteria. Platelet survival was measured by Indium111 labeling. Acute and convalescent samples were analyzed for fibrinogen, factor VIIIc, antithrombin III (AT III), fibrin/fibrinogen degradation products (FDPs), and platelet aggregation. The results suggest that in the active stage of the disease: (1) hypercoagulability may be caused by a rise in acute phase reactants, (2) an acceleration of coagulation and fibrinolysis may supervene, and (3) in some cases there is a reduction in platelet aggregation, possibly as a result of continued circulation of previously activated “exhausted” platelets.

Key words

Endocarditis Coagulation Clotting factors AT III Platelets 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lerner PT (1985) Neurological complications of infective endocarditis. Symposium on infection of central nervous system. Med Clin North Am 69: 385–398PubMedGoogle Scholar
  2. 2.
    Durack DT, Beeson PB (1972) Experimental bacterial endocarditis. I. Colonisation of a sterile vegetation. Br J Exp Pathol 53: 44–49PubMedGoogle Scholar
  3. 3.
    Taha TH, Durrant S, Crick JCP, Oakley CM (1988) Hypercoagulability, consumptive coagulopathy and paradoxical reduction of platelet aggregation in infective endocarditis (abstract). Br Heart J 59: 129Google Scholar
  4. 4.
    Peters AM, Saverymuttu SH, Bell RN, Lavender JP (1985) The kinetics of short-lived Indium-III radio-labelled platelets. Scand J Haematol 34: 137–145PubMedGoogle Scholar
  5. 5.
    Dacie JV, Lewis SM (1984) Practical haematology. Churchill Livingstone, Edinburgh, pp 232–233Google Scholar
  6. 6.
    Meade T, Mellows S, Brozovic M, Miller GJ, Chakrabarti RR, North WRS, Haines AP, Stirling Y, Imeson JD, Thompson SG (1986) Haemostatic function and ischaemic heart disease: Principal results of Northwick Park Heart Study. Lancet II: 533–537Google Scholar
  7. 7.
    Murray HW, Tuazon CU, Sheagren JN (1977) Staphylococcal septicemia and disseminated intravascular coagulation. Arch Intern Med 137: 844–847PubMedGoogle Scholar
  8. 8.
    Stuart JJ, Breyer R (1984) Subacute bacterial endocarditis causing disseminated intravascular coagulation: Resolution after valve replacement. J Thorac Cardiovasc Surg 88: 454–456Google Scholar
  9. 9.
    Almer LO (1985) A case of brucellosis complicated by endocarditis and disseminated intravascular coagulation. Acta Med Scand 217: 139–140PubMedGoogle Scholar
  10. 10.
    Delcampo C (1985). Resolution of disseminated intravascular coagulation after valve replacement (letter). J Thorac Cardiovas Surg 89: 470–471Google Scholar
  11. 11.
    Fukuda Y, Kuroiwa Y, Tabuchi H, Ohshige T, Sanda J, Minami Y, Takaoka S, Kataoka H, Furukawa S, Miyahara K, Nakamura K, Hashimoto SL (1982) A thrombotic tendency in patients with infective endocarditis. Jpn Circ J 46: 460–467PubMedGoogle Scholar
  12. 12.
    Brown C III, Bradshaw MW, Natelson EA, Alfrey CP Jr, Temple WW Jr (1976). Defective platelet function following the administration of penicillin compounds. Blood 47: 949–956PubMedGoogle Scholar
  13. 13.
    Pareti FI, Capitanio A, Mannucci L, Porticelli, C, Mannucci PM (1980) Acquired dysfunction due to the circulation of “exhausted” platelets. Am J Med 69: 235–240PubMedGoogle Scholar
  14. 14.
    Fong JSC, Kaplan BS (1982) Impairment of platelet aggregation in hemolytic uremic syndrome: Evidence for platelet “exhaustion.” Blood 60: 564–570PubMedGoogle Scholar
  15. 15.
    Salzman EW (1963) Blood platelets and extra corporeal circulation transfusion. Transfusion 3: 274–277Google Scholar
  16. 16.
    Beurling-Harbury C, Glavon CA (1978) Acquired decrease in platelet secretory ADP associated with increased post-operative bleeding in post-cardiopulmonary bypass patients with severe valvular heart disease. Blood 52: 13–23PubMedGoogle Scholar
  17. 17.
    Johnson CE, Dewar HA (1982). Effect of sulphinpryrazone on the development of experimental endocardial vegetations. Cardiovasc Res 16: 657–662PubMedGoogle Scholar
  18. 18.
    Slichter SJ, Weiden PL, O'Donnell MR, Storb R (1982) Interruption of tumor-associated platelet consumption with platelet enzyme inhibitors. Blood 59: 1252–1258PubMedGoogle Scholar
  19. 19.
    Taha TH, Durrant SS, Mazeika PK, Nihoyannopoulos P, Oakley CM (1990) Aspirin to prevent growth of vegetations and cerebral emboli in infective endocarditis. Circulation (Suppl III) 82: III-420Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • Taha H. Taha
    • 1
  • Simon Durrant
    • 1
  • Jonathan Crick
    • 1
  • Stella Bowcock
    • 1
  • Anne Bradshaw
    • 1
  • Celia M. Oakley
    • 1
  1. 1.Department of Medicine (Clinical Cardiology and Haematology Units)Royal Postgraduate Medical School, Hammersmith HospitalLondonUK

Personalised recommendations