Tailored Decision of Anticoagulation in Patients With IE
A 72-year-old Caucasian female patient with known hypertension, dyslipidemia, type II diabetes, and atrial fibrillation presented with fever, chills, confusion, right facial droop, and right arm weakness. Her physical exam was notable for irregular rhythm with no focal neurologic signs. Laboratory investigations were notable for white blood cell count of 19.0 x 109 per L, C-reactive protein of 10.4 mg/dl, and erythrocyte sedimentation rate of 78 mm/hr. Magnetic resonance imaging showed punctate areas of acute infarction within posterior circulation and into the watershed region. Transthoracic echocardiogram showed an echodense mass attached to the posterior leaflet of mitral valve (Video 1, Figure 1). Transesophageal echocardiogram showed a larger mass with a fairly mobile component (Video 2, Figure 2). Blood cultures grew Staphylococcus aureus. The patient's home medication list included rosuvastatin, metoprolol, aspirin, metformin, glyburide, and warfarin. The patient was diagnosed with infective endocarditis (IE) and was started on vancomycin.
Video 1: Two-Dimensional Transthoracic Echocardiography in Parasternal Long Axis View.
Figure 1: Two-Dimensional Transthoracic Echocardiography in Parasternal Long Axis View.
Video 2: Two-Dimensional Transesophageal Echocardiography in Midesophageal View
Figure 2: Two-Dimensional Transesophageal Echocardiography in Midesophageal View
Which of the following statements is correct regarding anticoagulation therapy?