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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.
Journal of Community Hospital Internal Medicine Perspectives
|November 25, 2020
Summary
This case highlights recurrent nonbacterial thrombotic endocarditis (NBTE) and stroke despite anticoagulation. Antiphospholipid syndrome increases risks, even after valve replacement and anticoagulation therapy.
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.
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