Antithrombotic agents: Do they protect from infective endocarditis? A retrospective observational study using TriNetx

Abstract

Introduction: Infective endocarditis (IE) remains a severe infection associated with substantial morbidity and mortality. Given the central role of platelets in its pathogenesis, antithrombotic therapy has been hypothesized to exert a preventive effect, though clinical evidence remains inconclusive.

Methods: We conducted a retrospective, population-based study using the TriNetX Global Collaborative Network to assess the incidence of IE among individuals exposed to antiplatelet or anticoagulant therapy versus untreated controls. Propensity score matching accounted for major cardiovascular and metabolic comorbidities, and outcomes were evaluated over a 10-year follow-up period.

Results: In low-risk individuals, neither antiplatelet nor anticoagulant use significantly reduced IE incidence. In high-risk patients, only anticoagulant (HR 0.55, 95%CI 0.29-1.07) therapies non-significantly reduced IE risk.

Conclusion: Antithrombotic therapy has not demonstrated protective effects against infective endocarditis. These findings warrant prospective studies to elucidate mechanisms and confirm safety.

Keywords: Antiagregante; Anticoagulant; Anticoagulante; Antiplatelet; Antithrombotic; Antitrombótico; Endocarditis; Endocarditis infecciosa; Infectious endocarditis; Profilaxis; Prophylaxis; TriNetX.