Improvement of Cardiac Vegetations in Antiphospholipid Syndrome with Enoxaparin and Corticosteroids after Rivaroxaban Failure

Abstract

Cardiac disease is a well-known complication of antiphospholipid syndrome (APS), with many patients presenting with valvular thickening or vegetations, referred to as Libman–Sacks endocarditis (LSE). Because cases of APS with cardiac involvement are relatively rare, paucity of large clinical trials studying this complication has made management challenging. In the absence of acute heart failure and embolic events, a medical approach is usually selected, consisting of anticoagulation and possibly corticosteroids when another underlying autoimmune disease is present. However, the role of various anticoagulant classes and the duration of steroid therapy continue to be debated. Here, we present a 45-year-old woman who developed two vegetations in the setting of secondary APS while taking rivaroxaban before experiencing marked improvement with the use of enoxaparin and steroids.

Embolic myocardial infarction with cardiac arrest as an initial manifestation of non-bacterial thrombotic endocarditis

“…Without valve surgery, NBTE was assumed to be progressive and associated with high rates of future embolic events 16. However, the use of anti-inflammatory medication and anticoagulation has been shown to improve or resolve valvular lesions 17. Our patient ultimately passed away from complications of hypercoagulability that would not have been addressed by valve surgery suggesting that treatment of the underlying condition precipitating the NBTE is crucial to patient care.…”

Young Stroke Following Libman-Sacks Endocarditis associated with Systemic Lupus Erythematosus and Secondary Antiphospholipid Antibody Syndrome

“…7 There is no clear role regarding administration of glucocorticoid and/or cytotoxic therapy for valvular lesions, due to scarcity of clinical evidence. 8,9 Some valvular abnormalities respond to anticoagulation therapy. Anticoagulation therapy is similar in patients without valvular lesions in the presence of APLS.…”