A randomized trial of aspirin on the risk of embolic events in patients with infective endocarditis
Open accessAbstract
Objectives This study examined the effect of aspirin on the risk of embolic events in infective endocarditis (IE).Background Embolism is a major complication of IE, and studies in animal models have shown that platelet inhibition with aspirin can lead to more rapid vegetation resolution and a lower rate of embolic events.Methods We conducted a randomized, double-blinded, placebo-controlled trial of aspirin treatment (325 mg/day) for four weeks in patients with IE to test the hypothesis that the addition of aspirin would reduce the incidence of clinical systemic embolic events. Patients with perivalvular abscess were excluded. Serial cerebral computed tomograms and transesophageal echocardiograms were obtained in a subset of patients.Results During the four-year study period, 115 patients were enrolled: 60 assigned to aspirin and 55 assigned to placebo. Embolic events occurred in 17 patients (28.3%) on aspirin and 11 patients (20.0%) on placebo, with an odds ratio (OR) of 1.62 (95% confidence interval [CI] 0.68 to 3.86, p = 0.29). There was a trend toward a higher incidence of bleeding in the patients taking aspirin versus placebo (OR 1.92, 95% CI 0.76 to 4.86, p = 0.075). Development of new intracranial lesions was similar in both groups. Aspirin had no effect on vegetation resolution and valvular dysfunction.Conclusions In endocarditis patients already receiving antibiotic treatment, the addition of aspirin does not appear to reduce the risk of embolic events and is likely associated with an increased risk of bleeding. Aspirin is not indicated in the early management of patients with IE.
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No significant benefit was observed in aspirin-treated patients in terms of vegetation resolution and embolic events, and there was a trend toward more bleeding episodes in the aspirin-treated patients.
“No significant benefit was observed in aspirin-treated patients in terms of vegetation resolution and embolic events.Moreover, there was a trend toward more bleeding episodes in the aspirin-treated patients.”
A randomized trial compared oral aspirin 325 mg/d with placebo in 115 infective endocarditis patients.
“a randomized trial compared oral aspirin 325 mg/d with placebo in 115 IE patients.288”
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- Authors
- Chan, K.-L., Dumesnil, J. G., Cujec, B., Sanfilippo, A. J., Jue, J., Turek, M. A., Robinson, T. I., & Moher, D.
- Affiliations
- University of Ottawa (CA)
- Queen's University (CA)
- University of British Columbia (CA)
- University of Toronto (CA)
- Corresponding author
- Chan, Kwan-Leung
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2003-09
- Volume
- 42
- Issue
- 5
- Pages
- 775-780
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2119369213
- Semantic Scholar
- 013a6c749e737017ab51a465a2804e3f457286dd
- Cited by
- 244
- References
- 50
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 6 · 2023: 15 · 2022: 7 · 2021: 11 · 2020: 21 · 2019: 9 · 2018: 3 · 2017: 6 · 2016: 14 · 2015: 11 · 2014: 12 · 2013: 13 · 2012: 14
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- University of Ottawa
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- aspirin, infective endocarditis, embolic events, systemic embolism, platelet aggregation inhibition, bleeding risk, intracranial lesions, valvular dysfunction, antibiotic therapy
- MeSH terms
- Aged, Anti-Bacterial Agents, Aspirin, Double-Blind Method, Drug Therapy, Combination, Embolism, Endocarditis, Bacterial, Female, Follow-Up Studies, Hemorrhage, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors, Risk Factors, Severity of Illness Index, Tomography, X-Ray Computed, Incidence, Proportional Hazards Models, Odds Ratio, Single-Blind Method, Treatment Outcome, Echocardiography, Transesophageal
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