Reversibility of valve regurgitation due to cancer-related non-bacterial thrombotic endocarditis after switching direct oral anticoagulation for heparin.

Abstract

Non-bacterial thrombotic endocarditis (NBTE) is a rare condition related to a state of hypercoagulability in advanced neoplastic disease. Most of the time, arterial thromboembolic event precedes the diagnosis of NBTE. We report here a case of NBTE responsible for multiple ischaemic strokes, which leads to the diagnosis of metastatic pancreatic adenocarcinoma. Aortic and mitral valvular regurgitations secondary to NBTE appeared within 6 weeks despite therapeutic anticoagulation with direct oral anticoagulant (DOAC) in stroke prevention of paroxysmal atrial fibrillation. Bivalvular regurgitations resolved 8 weeks after therapeutic switch to low-molecular-weight heparin (LMWH) and chemotherapy. DOACs are a possible alternative to LMWH for the prevention of venous thromboembolism in patients with active neoplasia. There is a lack of evidence for a clinical efficiency for the prevention of arterial thromboembolism in NBTE. We propose here a short review of the efficacy of anticoagulant therapy for the prevention of arterial thromboembolism in NBTE.

• Authors: Maxence Lepour, Grégoire J F G Wieërs, Justine Vereeke, Aurélien Wauters
• Journal: BMJ case reports (BMJ Case Rep) Vol. 15 Issue 3 (Mar 16 2022) ISSN: 1757-790X [Electronic] England
• PMID: 35296493 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Anticoagulants
• Heparin, Low-Molecular-Weight
• Heparin

Topics

• Adenocarcinoma (drug therapy)
• Anticoagulants (therapeutic use)
• Endocarditis, Non-Infective (diagnosis, drug therapy, etiology)
• Heparin
• Heparin, Low-Molecular-Weight (therapeutic use)
• Humans
• Pancreatic Neoplasms (complications, drug therapy)