Skip to main content
SpringerLink
Log in

Impact of Antiplatelet Therapy on Clinical Manifestations and Outcomes of Cardiovascular Infections

  • Cardiovascular Infections (D Levine, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Despite advances in medical and surgical management, infective endocarditis remains associated with significant morbidity and mortality. Septic embolization to the brain and other organs is one of the most dreaded complications of infective endocarditis. Given the critical role of platelets in bacterial vegetation formation on cardiac valves or cardiac device leads, antiplatelet agents, including aspirin, have recently generated much interest as adjunctive therapies in cardiovascular infections. In this article, we review the published evidence evaluating the role of platelets in the pathogenesis of cardiovascular infections and the rationale for using antiplatelet agents in these infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Le KY, Sohail MR, Friedman PA, et al. Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Hear Rhythm. 2011;8:1678–85.

    Article  Google Scholar 

  2. Sohail MR, Henrikson CA, Braid-Forbes MJ, Forbes KF, Lerner DJ. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med. 2011;171:1821–8.

    Article  PubMed  Google Scholar 

  3. Sohail MR, Uslan DZ, Khan AH, et al. Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol. 2007;49:1851–9.

    Article  PubMed  Google Scholar 

  4. Tleyjeh IM, Steckelberg JM, Murad HS, et al. Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. JAMA. 2005;293:3022–8.

    Article  PubMed  CAS  Google Scholar 

  5. Vilacosta I, Graupner C, San Roman JA, et al. Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol. 2002;39:1489–95.

    Article  PubMed  Google Scholar 

  6. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:e1–142.

    Article  PubMed  Google Scholar 

  7. Kim DH, Kang DH, Lee MZ, et al. Impact of early surgery on embolic events in patients with infective endocarditis. Circulation. 2010;122:S17–22.

    Article  PubMed  Google Scholar 

  8. Clawson CC, Rao GH, White JG. Platelet interaction with bacteria. IV. Stimulation of the release reaction. Am J Pathol. 1975;81:411–20.

    PubMed  CAS  Google Scholar 

  9. Fowler VG Jr, Scheld W, Bayer AS. Endocarditis and Intravascular Infections. In: Mandell GLBJ, Dolin R, editors. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009.

    Google Scholar 

  10. Kupferwasser LI, Yeaman MR, Shapiro SM, et al. Acetylsalicylic acid reduces vegetation bacterial density, hematogenous bacterial dissemination, and frequency of embolic events in experimental Staphylococcus aureus endocarditis through antiplatelet and antibacterial effects. Circulation. 1999;99:2791–7.

    Article  PubMed  CAS  Google Scholar 

  11. Scheld WM, Valone JA, Sande MA. Bacterial adherence in the pathogenesis of endocarditis. Interaction of bacterial dextran, platelets, and fibrin. J Clin Invest. 1978;61:1394–404.

    Article  PubMed  CAS  Google Scholar 

  12. Kupferwasser LI, Yeaman MR, Nast CC, et al. Salicylic acid attenuates virulence in endovascular infections by targeting global regulatory pathways in Staphylococcus aureus. J Clin Invest. 2003;112:222–33.

    PubMed  CAS  Google Scholar 

  13. Nicolau DP, Freeman CD, Nightingale CH, et al. Reduction of bacterial titers by low-dose aspirin in experimental aortic valve endocarditis. Infect Immun. 1993;61:1593–5.

    PubMed  CAS  Google Scholar 

  14. Nicolau DP, Marangos MN, Nightingale CH, Quintiliani R. Influence of aspirin on development and treatment of experimental Staphylococcus aureus endocarditis. Antimicrob Agents Chemother. 1995;39:1748–51.

    Article  PubMed  CAS  Google Scholar 

  15. Nicolau DP, Tessier PR, Nightingale CH. Beneficial effect of combination antiplatelet therapy on the development of experimental Staphylococcus aureus endocarditis. Int J Antimicrob Agents. 1999;11:159–61.

    Article  PubMed  CAS  Google Scholar 

  16. Nicolau DP, Tessier PR, Nightingale CH, Quintiliani R. Influence of adjunctive ticlopidine on the treatment of experimental Staphylococcus aureus endocarditis. Int J Antimicrob Agents. 1998;9:227–9.

    Article  PubMed  CAS  Google Scholar 

  17. Domenico P, Schwartz S, Cunha BA. Reduction of capsular polysaccharide production in Klebsiella pneumoniae by sodium salicylate. Infect Immun. 1989;57:3778–82.

    PubMed  CAS  Google Scholar 

  18. Polonio RE, Mermel LA, Paquette GE, Sperry JF. Eradication of biofilm-forming Staphylococcus epidermidis (RP62A) by a combination of sodium salicylate and vancomycin. Antimicrob Agents Chemother. 2001;45:3262–6.

    Article  PubMed  CAS  Google Scholar 

  19. Taha TH, Durrant SS, Mazeika PK, Nihoyannopoulos P, Oakley CM. Aspirin to prevent growth of vegetations and cerebral emboli in infective endocarditis. J Intern Med. 1992;231:543–6.

    Article  PubMed  CAS  Google Scholar 

  20. Chan KL, Dumesnil JG, Cujec B, et al. A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis. J Am Coll Cardiol. 2003;42:775–80.

    Article  PubMed  CAS  Google Scholar 

  21. Chan KL, Tam J, Dumesnil JG, et al. Effect of long-term aspirin use on embolic events in infective endocarditis. Clin Infect Dis. 2008;46:37–41.

    Article  PubMed  Google Scholar 

  22. Anavekar NS, Tleyjeh IM, Mirzoyev Z, et al. Impact of prior antiplatelet therapy on risk of embolism in infective endocarditis. Clin Infect Dis. 2007;44:1180–6.

    Article  PubMed  Google Scholar 

  23. •• Anavekar NS, Schultz JC, De Sa DD, et al. Modifiers of symptomatic embolic risk in infective endocarditis. Mayo Clin Proc. 2011;86:1068–74. This study showed that embolization risk in patients with endocarditis was significantly less in patients receiving statin therapy, but not with chronic antiplatelet therapy. Neither chronic statin therapy nor aspirin therapy had a significant effect on 6-month mortality.

  24. Serebruany VL, Miller M, Pokov AN, et al. Effect of statins on platelet PAR-1 thrombin receptor in patients with the metabolic syndrome (from the PAR-1 inhibition by statins [PARIS] study). Am J Cardiol. 2006;97:1332–6.

    Article  PubMed  CAS  Google Scholar 

  25. Tleyjeh IM, Kashour T, Hakim FA, et al. Statins for the prevention and treatment of infections: a systematic review and meta-analysis. Arch Intern Med. 2009;169:1658–67.

    Article  PubMed  Google Scholar 

  26. • Snygg-Martin U, Rasmussen RV, Hassager C, Bruun NE, Andersson R, Olaison L. The relationship between cerebrovascular complications and previously established use of antiplatelet therapy in left-sided infective endocarditis. Scand J Infect Dis. 2011;43:899–904. This study showed no significant reduction in cerebrovascular complication rate in endocarditis patients receiving chronic antiplatelet therapy.

  27. • Eisen DP, Corey GR, McBryde ES, et al. Reduced valve replacement surgery and complication rate in Staphylococcus aureus endocarditis patients receiving acetyl-salicylic acid. J Infect. 2009;58:332–8. This was a randomized trial that showed that recent aspirin therapy was associated with reduced rate of acute valve replacement surgery without a significant effect on rate of embolization or hemorrhagic stroke.

  28. Pepin J, Tremblay V, Bechard D, et al. Chronic antiplatelet therapy and mortality among patients with infective endocarditis. Clin Microbiol Infect. 2009;15:193–9.

    Article  PubMed  CAS  Google Scholar 

  29. •• Habib A, Le KY, Baddour LM, et al. Predictors of Mortality in Patients With Cardiovascular Implantable Electronic Device Infections. Am J Cardiol 2012. This study showed that patients with CIED infection that were on chronic aspirin therapy were less likely to have vegetations on cardiac device leads or heart valves, and less likely to have systemic manifestations of infection. There was no significant difference in mortality or pathogen distribution, however.

  30. Greenspon AJ, Prutkin JM, Sohail MR, et al. Timing of the most recent device procedure influences the clinical outcome of lead-associated endocarditis results of the MEDIC (Multicenter Electrophysiologic Device Infection Cohort). J Am Coll Cardiol. 2012;59:681–7.

    Article  PubMed  Google Scholar 

  31. Le KY, Sohail MR, Friedman PA, et al. Clinical predictors of cardiovascular implantable electronic device-related infective endocarditis. Pacing Clin Electrophysiol. 2011;34:450–9.

    Article  PubMed  Google Scholar 

  32. Habib A, Irfan M, Baddour LM, et al. Impact of prior aspirin therapy on clinical manifestations of cardiovascular implantable electronic device infections. Europace 2012.

  33. Jagneaux T, Taylor DE, Kantrow SP. Coagulation in sepsis. Am J Med Sci. 2004;328:196–204.

    Article  PubMed  Google Scholar 

  34. Hart RG, Kagan-Hallet K, Joerns SE. Mechanisms of intracranial hemorrhage in infective endocarditis. Stroke. 1987;18:1048–56.

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Ammar Habib, Larry M. Baddour, and M. Rizwan Sohail declare that they have no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Medicine (A.H.), Mayo School of Graduate Medical Education, Rochester, MN, USA

    Ammar Habib, Larry M. Baddour & M. Rizwan Sohail

  2. Divisions of Infectious Diseases and Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Ammar Habib, Larry M. Baddour & M. Rizwan Sohail

Authors
  1. Ammar Habib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larry M. Baddour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Rizwan Sohail
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Rizwan Sohail.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Habib, A., Baddour, L.M. & Sohail, M.R. Impact of Antiplatelet Therapy on Clinical Manifestations and Outcomes of Cardiovascular Infections. Curr Infect Dis Rep 15, 347–352 (2013). https://doi.org/10.1007/s11908-013-0347-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-013-0347-z

Keywords

Search

Navigation