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

BMJ Case Rep. 2022 Mar 16;15(3):e247672. doi: 10.1136/bcr-2021-247672.

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.

Keywords: Cancer intervention; Cardiovascular system; Heart failure; Pancreatic cancer; Valvar diseases.

Publication types

  • Case Reports

MeSH terms

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

Substances

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