Predictive value of thromboembolic complications in infective endocarditis, the possibility of prevention.

Abstract

Thromboembolic syndrome is a formidable complication of infectious endocarditis (IE), which significantly worsens the prognosis. Data of literature and own results of studying of this problem are given. Among 64 patients of IE, who were under the supervision of the authors, thromboembolic syndrome was observed in 23 (36%; according to the literature - in 33-50%), including recurrent in 6. The main causative agent of the disease in this group was Staphylococcus aureus (42%), which is consistent with the data of the majority of authors, in the presence of large mobile vegetation with localization on the mitral valve, among patients without embolic events - Streptococcus viridans (47%) in the presence of smaller vegetation mainly on the aortic valve. The most dangerous thromboembolic complication was ischemic stroke in 8 (12.5%) patients, but embolic heart attack of the brain and myocardium is not always diagnosed in patients due to atypical course. The basis for the treatment and prevention of complications of IE, including thromboembolism, is early initiated adequate antibiotic therapy; at the same time, the principles of antithrombotic therapy in IE developed less. Given the high risk of intracranial hemorrhages, the decision to conduct thrombolytic therapy should be made individually by the so-called endocarditis team. The article discusses the indications for urgent surgical treatment to prevent thromboembolism.