Case report: New is not always better: treatment of non-bacterial thrombotic endocarditis

Elias Akiki; Ali Ahmad; Edward A El-Am; Ana I Casanegra; Kyle W Klarich; Reto Kurmann

doi:10.3389/fcvm.2023.1208190

Case report: New is not always better: treatment of non-bacterial thrombotic endocarditis

Front Cardiovasc Med. 2023 Jul 12:10:1208190. doi: 10.3389/fcvm.2023.1208190. eCollection 2023.

Authors

Elias Akiki¹, Ali Ahmad^{1

2}, Edward A El-Am¹, Ana I Casanegra¹, Kyle W Klarich¹, Reto Kurmann¹

Affiliations

¹ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
² Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States.

Abstract

An elderly female with metastatic adenocarcinoma of the lung and atrial fibrillation presented with multiple embolic strokes while on anticoagulation with Apixaban. After further investigation, a TEE showed lesions of non-bacterial thrombotic endocarditis on the mitral valve. A decision to switch the patient to LMWH for anticoagulation was then made and a follow-up TEE showed resolution of the NBTE. In this abstract, we show that heparin should remain as the anticoagulation agent of choice in the setting of NBTE associated with malignancy.

Keywords: DOAC; anticoagulation; apixaban; embolic stroke; heparin; non-bacterial thrombotic endocarditis; warfarin.

Publication types

Case Reports