Non-bacterial thrombotic endocarditis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
There is no treatment for | 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== | ==Medical Therapy== | ||
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*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>. | *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>. | ||
*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>. | *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>. | ||
* | *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>. | ||
*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>. | *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>. | ||
Latest revision as of 15:05, 25 August 2020
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non-bacterial thrombotic endocarditis |
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Differentiating non-bacterial thrombotic endocarditis from other Diseases |
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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
- ↑ 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.
- ↑ 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.
- ↑ 3.0 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.
- ↑ 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.
- ↑ 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.