Nonbacterial thrombotic endocarditis: A rare manifestation of gynecologic cancer

Orfanelli, Theofano; Sultanik, Elliot; Shell, Roger; Gibbon, Darlene

doi:10.1016/j.gore.2016.05.010

Cited by 8 publications

(10 citation statements)

References 11 publications

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“…Valvular vegetation disappeared after 5 days of treatment with UFH. We found one other case (Orfanelli et al ) of resolution of monovalvular vegetations after switching DOAC to heparin therapy 10. Valvular progression was rapid, within weeks, in the cases that report ultrasonographic follow-up.DOAC, direct oral anticoagulant; LMWH, low -molecular- weight heparin; NBTE, non-bacterial thrombotic endocarditis; UFH, unfractionated heparin; VTED, venous thromboembolic disease.…”

Section: Discussionmentioning

confidence: 86%

“…Our case report and others (table 1) support that DOACs are insufficient to prevent arterial thromboembolism in NBTE. Moreover, the three cases that reported regression of valvular regurgitation and vegetations were treated with heparin, suggesting a curative effect 8–10. This difference could be due to pleiotropic effects of heparin beyond inactivation of factor Xa and thrombin as reduction of platelet aggregation 11…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…However, there are again no clear guidelines on the optimal anticoagulant [2, 3]. Although there is no consensus on the preference between LMWH and unfractionated heparin, both are recommended over warfarin in the treatment of malignancy-induced hypercoagulable states [8, 10, 21]. Recent evidence indicates a potential role for direct oral anticoagulants (DOACs) in patients with cancer with venous thrombosis, but more evidence is needed before widespread use of DOACs in malignancy becomes standard practice [3, 22].…”

Section: Discussionmentioning

confidence: 99%

Stroke in malignancy: complexities of diagnosis and management: a case report

2019

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Background Although there is an established association between cancer and stroke, the role of malignancy as a causative agent or comorbidity is not always clear. Moreover, there are no established guidelines on the acute treatment of cancer-associated stroke or optimal anticoagulation. This case report illustrates the significance of these practice gaps. Case presentation A 62-year-old Caucasian woman presented to our institute with acute neurological deficits and was found to have an occluded left middle cerebral artery on a computed tomographic angiogram. She was administered intravenous alteplase and underwent unsuccessful endovascular clot retrieval. Besides smoking and her age, she had no cerebrovascular risk factors, and the results of baseline investigations for the cause of stroke were negative. Subsequent computed tomography of the chest, abdomen, and pelvis showed metastatic malignancy, and in the context of a significantly elevated serum cancer antigen 19-9, we suspected a pancreatic primary cancer. A transthoracic echocardiogram demonstrated mitral regurgitation but no visible vegetation. The patient died of her illness. We made a diagnosis of cancer-associated stroke, specifically a likely case of nonbacterial thrombotic endocarditis. Conclusions This case highlights the importance of having a high threshold of suspicion for malignancy as a cause of stroke.

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“…Furthermore, NBTE as the presenting sign of occult malignancy is rarely reported in the literature. 11,12 Amaurosis fugax as the presenting symptom of NBTE associated with lung adenocarcinoma has not been previously reported.…”

Section: Amaurosis Fugax As the Presenting Symptom Of Metastatic Lungmentioning

confidence: 95%

Amaurosis fugax as the presenting symptom of metastatic lung adenocarcinoma

Han

Siegfried

Stavern

2019

Canadian Journal of Ophthalmology

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Nonbacterial thrombotic endocarditis: A rare manifestation of gynecologic cancer

Cited by 8 publications

References 11 publications

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

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

Stroke in malignancy: complexities of diagnosis and management: a case report

Amaurosis fugax as the presenting symptom of metastatic lung adenocarcinoma

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