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Infective Endocarditis — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionInfective EndocarditisSCE Infectious Diseases

A 50-year-old woman with a metallic mitral valve replacement takes Warfarin (INR target 2.5–3.5). She develops Staphylococcus aureus prosthetic valve endocarditis. Cerebral MRI shows multiple small embolic infarcts but no haemorrhage. What is the recommended approach to anticoagulation?

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Correct answer: E — Continue Warfarin with close INR monitoring; avoid switching to Heparin unless surgery is imminent

Anticoagulation management in prosthetic valve endocarditis with embolic stroke is challenging. Current ESC 2023 guidelines recommend continuing oral anticoagulation (Warfarin) with close INR monitoring for patients with mechanical valves, as the thromboembolic risk of stopping outweighs the haemorrhagic risk (in the absence of haemorrhagic transformation). Warfarin should be temporarily withheld only if intracranial haemorrhage occurs or if surgery is planned. DOACs are contraindicated with mechanical heart valves.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections