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Reversibility of valve regurgitation due to cancer-related non-bacterial thrombotic endocarditis after switching direct oral anticoagulation for heparin
  1. Maxence Lepour1,
  2. Grégoire J F G Wieërs2,3,
  3. Justine Vereeke1 and
  4. Aurélien Wauters1
  1. 1 Department of Cardiology, Clinique Saint Pierre, Ottignies, Belgium
  2. 2 General Internal Medicine, Clinique Saint-Pierre, Ottignies, Belgium
  3. 3 Department of Medicine, Université de Namur, Namur, Belgium
  1. Correspondence to Dr Grégoire J F G Wieërs; gregoire.wieers{at}cspo.be

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.

  • Heart failure
  • Valvar diseases
  • Cancer intervention
  • Cardiovascular system
  • Pancreatic cancer

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Footnotes

  • Contributors ML and GJFGW wrote the paper. ML obtained the informed consent from the patient. AW and JV performed the echocardiography and gave feed back on the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.