Skip to content
DraconiticResearch
Search Sources API
197,768 studies31 sourcesUpdated 12 min ago
Peer-reviewedCC BY 4.0Neurological Research and Practice

Characterization and treatment of ischemic stroke in patients with infective endocarditis: a meta‐analysis

  • Nils Werring1
  • Nadine Bonberg2
  • Andreas Heidenreich3
  • Carolin Beuker4
  • Greta Noblejas-Sanchez1
  • Michelle Oswald1
  • Georg Royl1
  • Tobias A. Wagner-Altendorf1
  • Tanja Zeller5,6
  • Thomas Stiermaier7,6
  • Ingo Eitel7,6
  • Alexander Katalinic3
2 more authors
  • Heike Minnerup2
  • Jens Minnerup1,6
7 affiliations
  1. 1University of Luebeck, Department of Neurology, Luebeck, Germany
  2. 2Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
  3. 3University of Luebeck, Institute of Social Medicine and Epidemiology, Luebeck, Germany
  4. 4Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
  5. 5University of Luebeck, Institute of Cardiogenetics, Luebeck, Germany
  6. 6partner site North, DZHK (German Center for Cardiovascular Research), Lübeck, Germany
  7. 7University of Luebeck, Medical Clinic II, University Heart Center Luebeck, Luebeck, Germany
Read full textPDFDOICite

Abstract

Background: Ischemic stroke is a common and serious complication of infective bacterial endocarditis. This study aimed to characterize the frequency, clinical and pathological features, treatment strategies, and outcomes of patients with stroke due to infective endocarditis.

Methods: We systematically searched PubMed from database inception to October 2022 for studies reporting on stroke in patients with infective endocarditis and performed a meta-analysis.

Results: A total of 122 studies comprising 270,211 patients with infective endocarditis were included. Ischemic stroke occurred in 21% and hemorrhagic stroke in 5% of patients. Stroke was observed in 32% of patients with mitral valve endocarditis, 25% with aortic valve, and 11% with tricuspid valve endocarditis. Stroke was associated with significantly higher mortality (OR 2.35; 95%CI 1.74–3.16). Staphylococcus and Streptococcus species were most frequently associated with stroke (33% and 25%, respectively). The risk of stroke did not differ significantly between patients with and without pre-existing antithrombotic therapy (37% vs. 24%; OR 1.24, 95%CI 0.75–2.06). Successful reperfusion was achieved in 80% of patients undergoing mechanical thrombectomy, although mortality remained high at 49%.

Conclusions: Stroke is a common complication of infective bacterial endocarditis and has a substantial impact on patient outcomes. It occurs most frequently in patients with mitral valve endocarditis and in those with infections caused by staphylococcal pathogens. Stroke risk was not reduced in patients with pre-existing antithrombotic therapy, supporting discontinuation where no other indication exists. Mechanical thrombectomy in patients with endocarditis-related large vessel occlusion achieves high recanalization rates; however, overall clinical outcomes remain poor in this population.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s42466-026-00542-z.

Related

  1. PO070 | INFECTIVE ENDOCARDITIS AND ISCHEMIC CEREBRAL EVENTS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND TRIPLE ANTIPHOSPHOLIPID POSITIVITY: THE ROLE OF ANTICOAGULATION IN PRIMARY PREVENTION
    Tommaso Marrazzo
    Bleeding, Thrombosis and Vascular BiologyPeer-reviewedCC BY-NCFull textCardiovascular medicineDOAJ
  2. Admission to a referral centre and one-year mortality among patients with infective endocarditis in a French multicentre cohort
    Benjamin Lefèvre, Marie-Line Erpelding, Yoann Dominique +9
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textGeneral biologyCardiovascular medicineHAL
  3. External Validation of the PACTO Risk Score for Infective Endocarditis in Patients With Coagulase-Negative Staphylococcal Bacteremia: A Multicenter Cohort Study.
    Antonio Ramos-Martínez, Itziar Diego-Yagüe, Luis Eduardo López-Cortés +10
    Open forum infectious diseasesPeer-reviewedCC BYFull textEpidemiology & public healthEurope PMC
  4. Antibiotic Prophylaxis of Infective Endocarditis in Dentistry: An Update on the ESC, AHA, and NICE Guidelines
    Journal of clinical medicinePeer-reviewedCC BYFull textGeneral medicineEurope PMC
  5. Robotic tricuspid valve repair for infective endocarditis with leaflet perforation and severe tricuspid regurgitation
    Shaan Asif, George Comas, Richard Bloomingdale +1
    JTCVS techniquesPeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{werring2026characterization,
  title = {{Characterization and treatment of ischemic stroke in patients with infective endocarditis: a meta‐analysis}},
  author = {Nils Werring and Nadine Bonberg and Andreas Heidenreich and Carolin Beuker and Greta Noblejas-Sanchez and Michelle Oswald and Georg Royl and Tobias A. Wagner-Altendorf and Tanja Zeller and Thomas Stiermaier and Ingo Eitel and Alexander Katalinic and Heike Minnerup and Jens Minnerup},
  journal = {Neurological Research and Practice},
  year = {2026},
  month = oct,
  doi = {10.1186/s42466-026-00542-z},
  url = {https://doi.org/10.1186/s42466-026-00542-z},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Characterization and treatment of ischemic stroke in patients with infective endocarditis: a meta‐analysis
AU  - Nils Werring
AU  - Nadine Bonberg
AU  - Andreas Heidenreich
AU  - Carolin Beuker
AU  - Greta Noblejas-Sanchez
AU  - Michelle Oswald
AU  - Georg Royl
AU  - Tobias A. Wagner-Altendorf
AU  - Tanja Zeller
AU  - Thomas Stiermaier
AU  - Ingo Eitel
AU  - Alexander Katalinic
AU  - Heike Minnerup
AU  - Jens Minnerup
PY  - 2026
DA  - 2026/10/26
JO  - Neurological Research and Practice
DO  - 10.1186/s42466-026-00542-z
UR  - https://doi.org/10.1186/s42466-026-00542-z
AB  - Background: Ischemic stroke is a common and serious complication of infective bacterial endocarditis. This study aimed to characterize the frequency, clinical and pathological features, treatment strategies, and outcomes of patients with stroke due to infective endocarditis.  Methods: We systematically searched PubMed from database inception to October 2022 for studies reporting on stroke in patients with infective endocarditis and performed a meta-analysis.  Results: A total of 122 studies comprising 270,211 patients with infective endocarditis were included. Ischemic stroke occurred in 21% and hemorrhagic stroke in 5% of patients. Stroke was observed in 32% of patients with mitral valve endocarditis, 25% with aortic valve, and 11% with tricuspid valve endocarditis. Stroke was associated with significantly higher mortality (OR 2.35; 95%CI 1.74–3.16). Staphylococcus and Streptococcus species were most frequently associated with stroke (33% and 25%, respectively). The risk of stroke did not differ significantly between patients with and without pre-existing antithrombotic therapy (37% vs. 24%; OR 1.24, 95%CI 0.75–2.06). Successful reperfusion was achieved in 80% of patients undergoing mechanical thrombectomy, although mortality remained high at 49%.  Conclusions: Stroke is a common complication of infective bacterial endocarditis and has a substantial impact on patient outcomes. It occurs most frequently in patients with mitral valve endocarditis and in those with infections caused by staphylococcal pathogens. Stroke risk was not reduced in patients with pre-existing antithrombotic therapy, supporting discontinuation where no other indication exists. Mechanical thrombectomy in patients with endocarditis-related large vessel occlusion achieves high recanalization rates; however, overall clinical outcomes remain poor in this population.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s42466-026-00542-z.
SN  - 2524-3489
ER  -