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.

Thrombosis of Chiari’s network in the setting of non-bacterial thrombotic endocarditis occurring under non-vitamin K antagonist oral anticoagulation: a case report

“… 9 NOACs have not been evaluated and seem inefficient as reported by some case reports in the literature. 12 , 13 , 14 , 15 …”

Non-bacterial thrombotic endocarditis in a patient with COVID

“…Newer studies have suggested that heparin or LWMH would be preferred in cases of malignancy-associated NBTE, while Vitamin K antagonists (VKA) agonists like warfarin may be preferred in antiphospholipid syndrome-associated NBTE 5 6. Multiple recent cases documented the failure of DOACs in treating NBTE 7–9. No studies have compared the efficacy of different anticoagulation strategies for NBTE to date.…”

“…5 Case report recent cases the failure of DOACs in treating NBTE. [7][8][9] No studies have compared the efficacy of different anticoagulation strategies for NBTE to date. A prospective multicentre trial is required to study the efficacy of the various anticoagulant regimens for NBTE, and whether these therapies should be tailored for patients with versus without underlying malignancy.…”