Title:Cancer-associated Marantic Endocarditis and Direct Oral Anticoagulants: Case Report and Systematic Review
Volume: 22
Issue: 3
Author(s): Glaudir Donato*, Filipe Castor, Joao Vitor Andrade Fernandes, Emilio Carlos de Arruda Lacerda, Ariane Vieira Scarlatelli Macedo and Marcelo Melo
Affiliation:
- Center of Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
Keywords:
Non-infective endocarditis, neoplasms, anticoagulants, transesophageal echocardiography, three-dimensional echocardiography, marantic endocarditis.
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 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 and Discussion: 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.
