Efficacy of oral aspirin in prevention of embolic events in infective endocarditis: A systematic review and meta analysis

Introduction

Infective endocarditis (IE) involves inflammation of the heart's inner lining and valves, leading to complications like embolic events. The role of aspirin in preventing these events is controversial, with concerns about bleeding risk, limiting its use. This meta-analysis evaluates the effectiveness of oral aspirin in preventing embolic events and its adverse outcomes in IE patients.

Methods

A systematic search was conducted on July 20, 2024, across PubMed/MEDLINE, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL for studies comparing aspirin to placebo or no treatment. The protocol was registered in PROSPERO (CRD42024573274).

Results

Five studies involving 1174 participants were included, with three eligible for meta-analysis due to data limitations. Findings on embolic event incidence were inconsistent: one randomized clinical trial (RCT) excluding prior aspirin therapy (OR 1.62, [0.68–3.86], p = 0.29) and a reanalysis examining long-term use (OR 0.80, [0.36–1.78], p = 0.582) found no significant reduction, while another study reported a possible reduction (OR 0.65, [0.43–0.98], p = 0.04). Bleeding rates trended higher in aspirin groups across two studies, though not statistically significant. Mortality data also varied; one study found higher mortality in aspirin users, while another associated chronic antiplatelet therapy with lower mortality, particularly with early initiation after admission.

Conclusion

Aspirin may reduce embolic events in IE, but evidence remains inconclusive due to mixed findings. Aspirin showed a non-significant increase in bleeding risk and mortality, so routine use for embolic prevention in IE is not recommended, highlighting the need for further research to clarify its potential role.