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Recurrent nonbacterial thrombotic endocarditis and stroke on anticoagulation.

Sijan Basnet1, Thomas Stauffer2, Amar Jayswal3

  • 1Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA.

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Summary

This case highlights recurrent nonbacterial thrombotic endocarditis (NBTE) and stroke despite anticoagulation. Antiphospholipid syndrome increases risks, even after valve replacement and anticoagulation therapy.

Keywords:
Nonbacterial thrombotic endocarditisantiphospholipid syndromerecurrent stroke

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Area of Science:

  • Cardiology
  • Neurology
  • Hematology

Background:

  • Antiphospholipid syndrome (APS) is a significant risk factor for thromboembolic events.
  • Nonbacterial thrombotic endocarditis (NBTE) can lead to embolic complications, including stroke.
  • Recurrent NBTE poses a therapeutic challenge, especially in patients with underlying prothrombotic conditions.

Observation:

  • A 48-year-old male with a history of APS, prior NBTE, and stroke presented with acute ischemic stroke.
  • The patient was on apixaban for anticoagulation at the time of the ischemic event.
  • NBTE of the mitral valve was diagnosed concurrently with the stroke.

Findings:

  • Despite therapeutic anticoagulation with enoxaparin, the patient experienced recurrent NBTE and stroke.
  • The patient underwent mitral valve replacement due to the severity of NBTE.
  • A subsequent hemorrhagic stroke occurred while on enoxaparin, leading to a fatal outcome.

Implications:

  • This case underscores the complex management of NBTE in patients with APS.
  • It highlights the potential for recurrent thrombotic events despite aggressive anticoagulation strategies.
  • The case emphasizes the need for careful consideration of anticoagulation intensity and potential complications in high-risk patients.