Non-bacterial thrombotic endocarditis medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There is no treatment for nonbacterial thrombotic endocarditis; the mainstay of therapy is the identification and treatment of the underlying condition, with an aim to reduce the risk of systemic embolism. Unless there is a specific contraindication, anticoagulation with IV unfractionated heparin or subcutaneous low molecular weight heparin is recommended in all patients with a clinical diagnosis of NBTE.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapy is recommended among all patients with non-bacterial thrombotic endocarditis<ref name="pmid3548296">{{cite journal |vauthors=Lopez JA, Ross RS, Fishbein MC, Siegel RJ |title=Nonbacterial thrombotic endocarditis: a review |journal=Am. Heart J. |volume=113 |issue=3 |pages=773–84 |date=March 1987 |pmid=3548296 |doi=10.1016/0002-8703(87)90719-8 |url=}}</ref>.  
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Due to the fragility of vegetation and the high rate of embolization in patients with NBTE, anticoagulation is recommended provided there are no contraindications<ref name="pmid17522239">{{cite journal |vauthors=el-Shami K, Griffiths E, Streiff M |title=Nonbacterial thrombotic endocarditis in cancer patients: pathogenesis, diagnosis, and treatment |journal=Oncologist |volume=12 |issue=5 |pages=518–23 |date=May 2007 |pmid=17522239 |doi=10.1634/theoncologist.12-5-518 |url=}}</ref>.
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*As there is a risk of conversion of embolism to hemorrhage, a base-line head CT is recommended prior to the start of anticoagulants<ref name="pmid22315272">{{cite journal |vauthors=Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH |title=Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e576S–e600S |date=February 2012 |pmid=22315272 |pmc=3278057 |doi=10.1378/chest.11-2305 |url=}}</ref>.
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
*IV unfractionated heparin or subcutaneous low molecular weight heparin is recommended<ref name="pmid22315272">{{cite journal |vauthors=Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH |title=Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e576S–e600S |date=February 2012 |pmid=22315272 |pmc=3278057 |doi=10.1378/chest.11-2305 |url=}}</ref>.
===Disease Name===
*Provided there are no acute contraindications, anticoagulation should be continued indefinitely in all patients<ref name="pmid30203033">{{cite journal |vauthors=Fujimoto D, Mochizuki Y, Nakagiri K, Shite J |title=Unusual rapid progression of non-bacterial thrombotic endocarditis in a patient with bladder cancer despite undergoing intensification treatment with rivaroxaban for acute venous thromboembolism |journal=Eur. Heart J. |volume=39 |issue=43 |pages=3907 |date=November 2018 |pmid=30203033 |doi=10.1093/eurheartj/ehy569 |url=}}</ref><ref name="pmid3674060">{{cite journal |vauthors=Rogers LR, Cho ES, Kempin S, Posner JB |title=Cerebral infarction from non-bacterial thrombotic endocarditis. Clinical and pathological study including the effects of anticoagulation |journal=Am. J. Med. |volume=83 |issue=4 |pages=746–56 |date=October 1987 |pmid=3674060 |doi=10.1016/0002-9343(87)90908-9 |url=}}</ref>.
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 15:05, 25 August 2020

non-bacterial thrombotic endocarditis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

There is no treatment for nonbacterial thrombotic endocarditis; the mainstay of therapy is the identification and treatment of the underlying condition, with an aim to reduce the risk of systemic embolism. Unless there is a specific contraindication, anticoagulation with IV unfractionated heparin or subcutaneous low molecular weight heparin is recommended in all patients with a clinical diagnosis of NBTE.

Medical Therapy

  • Pharmacologic medical therapy is recommended among all patients with non-bacterial thrombotic endocarditis[1].
  • Due to the fragility of vegetation and the high rate of embolization in patients with NBTE, anticoagulation is recommended provided there are no contraindications[2].
  • As there is a risk of conversion of embolism to hemorrhage, a base-line head CT is recommended prior to the start of anticoagulants[3].
  • IV unfractionated heparin or subcutaneous low molecular weight heparin is recommended[3].
  • Provided there are no acute contraindications, anticoagulation should be continued indefinitely in all patients[4][5].

References

  1. ↑ Lopez JA, Ross RS, Fishbein MC, Siegel RJ (March 1987). "Nonbacterial thrombotic endocarditis: a review". Am. Heart J. 113 (3): 773–84. doi:10.1016/0002-8703(87)90719-8. PMID 3548296.
  2. ↑ el-Shami K, Griffiths E, Streiff M (May 2007). "Nonbacterial thrombotic endocarditis in cancer patients: pathogenesis, diagnosis, and treatment". Oncologist. 12 (5): 518–23. doi:10.1634/theoncologist.12-5-518. PMID 17522239.
  3. ↑ 3.0 3.1 Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH (February 2012). "Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e576S–e600S. doi:10.1378/chest.11-2305. PMC 3278057. PMID 22315272.
  4. ↑ Fujimoto D, Mochizuki Y, Nakagiri K, Shite J (November 2018). "Unusual rapid progression of non-bacterial thrombotic endocarditis in a patient with bladder cancer despite undergoing intensification treatment with rivaroxaban for acute venous thromboembolism". Eur. Heart J. 39 (43): 3907. doi:10.1093/eurheartj/ehy569. PMID 30203033.
  5. ↑ Rogers LR, Cho ES, Kempin S, Posner JB (October 1987). "Cerebral infarction from non-bacterial thrombotic endocarditis. Clinical and pathological study including the effects of anticoagulation". Am. J. Med. 83 (4): 746–56. doi:10.1016/0002-9343(87)90908-9. PMID 3674060.

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