Cancer-Associated Marantic Endocarditis and Direct Oral Anticoagulants: Case Report and Systematic Review.

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Glaudir Donato, Filipe Castor, João Vitor Andrade Fernandes, Emilio Carlos de Arruda Lacerda, Ariane Vieira Scarlatelli Macedo, Marcelo Melo
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引用次数: 0

Abstract

Introduction: Nonbacterial thrombotic endocarditis (NBTE) involves sterile vegetations on heart valves due to systemic hypercoagulability, often linked to malignancies. It is frequently underdiagnosed and presents significant clinical management challenges, often manifesting as thromboembolic events like ischemic stroke. We aim to report the first case of cancerassociated NBTE that showed a positive response to rivaroxaban as a maintenance anticoagulant, with 3D echocardiographic evidence of vegetation reduction, and to evaluate the performance of direct oral anticoagulants (DOACs) in treating cancer-associated NBTE through a systematic review of case reports.

Methods: A case study and a systematic review of case reports on the use of DOACs in the setting of cancer-associated non-valvular atrial fibrillation (NVAF) were presented. Electronic databases were searched, and relevant studies were selected based on predefined eligibility criteria. Data were extracted and analyzed qualitatively, focusing on demographics, clinical presentation, anticoagulation and anticancer therapies, and outcomes (surgery, NBTE resolution, thromboembolic events, and mortality).

Results: In addition to our case, thirty-three studies were included in the systematic review. Most patients were already on DOAC therapy before the NBTE diagnosis. Lung and pancreatic cancers were the most common primary neoplasms. The aortic and mitral valves were most frequently affected. Anticoagulation therapy often shifted from DOACs to heparin upon NBTE diagnosis, with low-molecular-weight heparin showing better outcomes in vegetation resolution and thromboembolic event prevention.

Discussion: This study reinforces the suggestion that heparins are more appropriate for treating cancer-associated NBTE. However, satisfactory DOAC outcomes warrant further research.

Conclusion: Effective NBTE management with DOACs appears to be strongly associated with the successful control of the underlying neoplasm.

癌症相关的血管性心内膜炎和直接口服抗凝剂:病例报告和系统评价。
简介:非细菌性血栓性心内膜炎(NBTE)包括由于全身高凝性引起的心脏瓣膜无菌植被,通常与恶性肿瘤有关。它经常被误诊,并提出了重大的临床管理挑战,通常表现为血栓栓塞事件,如缺血性中风。我们的目标是报告第一例对利伐沙班作为维持性抗凝剂表现出积极反应的癌症相关NBTE病例,并通过三维超声心动图证据显示植被减少,并通过系统回顾病例报告来评估直接口服抗凝剂(DOACs)治疗癌症相关NBTE的性能。方法:对DOACs在癌症相关性非瓣膜性房颤(NVAF)治疗中的应用进行个案研究和系统回顾。检索电子数据库,并根据预先确定的资格标准选择相关研究。提取数据并进行定性分析,重点关注人口统计学、临床表现、抗凝和抗癌治疗以及结果(手术、NBTE解决、血栓栓塞事件和死亡率)。结果:除了我们的病例外,33项研究被纳入系统评价。大多数患者在NBTE诊断前已经接受了DOAC治疗。肺癌和胰腺癌是最常见的原发肿瘤。主动脉瓣和二尖瓣最常受影响。在NBTE诊断后,抗凝治疗通常从DOACs转向肝素,低分子量肝素在植被消退和血栓栓塞事件预防方面表现出更好的效果。讨论:这项研究强化了肝素更适合治疗癌症相关NBTE的建议。然而,令人满意的DOAC结果需要进一步的研究。结论:有效的NBTE治疗与DOACs似乎与成功控制潜在肿瘤密切相关。
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来源期刊
Current Cardiology Reviews
Current Cardiology Reviews CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
10.50%
发文量
117
期刊介绍: Current Cardiology Reviews publishes frontier reviews of high quality on all the latest advances on the practical and clinical approach to the diagnosis and treatment of cardiovascular disease. All relevant areas are covered by the journal including arrhythmia, congestive heart failure, cardiomyopathy, congenital heart disease, drugs, methodology, pacing, and preventive cardiology. The journal is essential reading for all researchers and clinicians in cardiology.
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