Reduced valve replacement surgery and complication rate in Staphylococcus aureus endocarditis patients receiving acetyl-salicylic acid

Damon P. Eisen, G. Ralph Corey, Emma S. McBryde, Vance G. Fowler, Jose M. Miro, Chris H. Cabell, Alan C. Street, Marcelo Goulart Paiva, Adina Ionac, Ru San Tan, Christophe Tribouilloy, Orathai Pachirat, Sandra Braun Jones, Natalia Chipigina, Christoph Naber, Angelo Pan, Veronica Ravasio, Rainer Gattringer, Vivian H. Chu, Arnold S. Bayeron behalf of the ICE Investigators

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Objectives: To assess the influence of acetyl-salicylic acid (ASA) on clinical outcomes in Staphylococcus aureus infective endocarditis (SA-IE). Methods: The International Collaboration on Endocarditis - Prospective Cohort Study database was used in this observational study. Multivariable analysis of the SA-IE cohort compared outcomes in patients with and without ASA use, adjusting for other predictive variables, including: age, diabetes, hemodialysis, cancer, pacemaker, intracardiac defibrillator and methicillin resistance. Results: Data were analysed from 670 patients, 132 of whom were taking ASA at the time of SA-IE diagnosis. On multivariable analysis, ASA usage was associated with a significantly decreased overall rate of acute valve replacement surgery (OR 0.58 [95% CI 0.35-0.97]; p < 0.04), particularly where valvular regurgitation, congestive heart failure or periannular abscess was the indication for such surgery (OR 0.46 [0.25-0.86]; p < 0.02). There was no reduction in the overall rates of clinically apparent embolism with prior ASA usage, and no increase in hemorrhagic strokes in ASA-treated patients. Conclusions: In this multinational prospective observational cohort, recent ASA usage was associated with a reduced occurrence of acute valve replacement surgery in SA-IE patients. Future investigations should focus on ASA's prophylactic and therapeutic use in high-risk and newly diagnosed patients with SA bacteremia and SA-IE, respectively. Crown

Original languageEnglish
Pages (from-to)332-338
Number of pages7
JournalJournal of Infection
Issue number5
Publication statusPublished - May 2009
Externally publishedYes


  • Acetyl-salicylic acid
  • Endocarditis
  • Staphylococcus aureus
  • Surgery

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