When do you start anticoagulation in patients with endocarditis and evidence of mycotic aneursym?

True estimates of the risk of anticoagulation in endocarditis is hard to come by, since anticoagulation is not common in practice and likely the risk is dynamic and decreases with antibiotic treatment. If one considers thrombolysis as a guide, the presence of endocarditis appears to increase the risk of symptomatic intracranial hemorrhage >3 fold (Asaithambi et al., PMID 23943218; Marquardt et al., PMID 31129109).

Especially in presence of a mycotic aneurysm and evidence of cerebral embolism, refraining from anticoagulation would be recommended. Common scenarios for indications for anticoagulation may be the following:

• comorbid atrial fibrillation--the absolute embolism risk from atrial fibrillation is much lower short term compared to comp...

I believe and had practiced that any kind of anticoagulants are contraindicated due to risk of bleeding. Mycotic aneurysms are the byproducts of infective endocarditis and therefore treating infective endocarditis is an emergency in order to prevent further formation of mycotic aneurysms and potential rupture.

I don't. What would the indication be?