AHA Guidelines on Endocarditis Medical Therapy

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease^[1]

Class I
"1. Appropriate antibiotic therapy should be initiated and continued after blood cultures are obtained with guidance from antibiotic sensitivity data and infectious disease consultants(Level of Evidence: B)"

Class IIa
"1. It is reasonable to temporarily discontinue anticoagulation in patients with IE who develop central nervous system symptoms compatible with embolism or stroke regardless of the other indications for anticoagulation (Level of Evidence: B)"

Class IIb
"1. Temporary discontinuation of VKA anticoagulation might be considered in patients receiving VKA anticoagulation at the time of IE diagnosis (Level of Evidence: B)"

Class III (Harm)
"1. Patients with known VHD should not receive antibiotics before blood cultures are obtained for unexplained fever. (Level of Evidence: C)"

↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 63 (22): 2438–88. doi:10.1016/j.jacc.2014.02.537. PMID 24603192.