relation between noneacterial thrombotic endocarditis and thromboembolism in patients with cancer

ABSTRACT

Patients with cancer are in hypercoagulable state. Nonbacterial thrombotic endocarditis [NBTE] can complicate any cancer. The major clinical manifestations of NBTE result from systemic emboli rather than valvular dysfunction. To assess the frequency and echocardiographic characteristics and to determine whether the presence of valvular lesions correlate with thrombo-embolic manifestations [TEM]. A prospective study conducted on 60 patients with different histopathological types of cancer and 10 healthy volunteers. A full medical history taking and physical examination were done and according to the performance status using the WHO score, the patients were classified into two groups of patients; group one, patients with good performance [grade I and II] and group two those with poor performance [III and IV]. Doppler echocardiography, chest-x-ray, abdominal sonography, and laboratory study including complete blood count [CBC]; bleeding time [BT]; prothrombin time and concentration [PT and PC]; Activated partial thromboplastin time [APTT] and serum level of both fibrinogen and D-dimer were done for all participants. Blood culture was done only for patients with NBTE. Doppler study of extremities and computed tomography [CT] of the brain were done for suspected patients with deep venous thrombosis [DVT] and cerebrovascular [CV] stroke respectively, NBTE was detected in 16 out of 60 patients [26.66%]. 22valve lesions were found; the aortic and mitral valves were the commonest sites [12 and 7 lesions respectively]. Valvular regurgitation was found in 12/60 patients [20%]; tricuspid regurgitation [TR] was the commonest lesion [42%]. The incidence of NBTE was higher in patients with poor performance than in those with good performance [p<0.001], and the highest incidence was in patients with adenocarcinoma of pancreas [50%]. Serum level of D-dimer ms higher in patients with NBTE than in those without NBTE [p<0.001]. The incidence of TEM was higher in patients with NBTE than in those without [62.5% versus 6.8%, p<0.001]. NBTE is not uncommon in patients with cancer. Aortic valve was the most commonly affected. Adenocarcinoma was the most frequent histologic type of related cancer. The major clinical manifestations of NBTE result from systemic emboli rather than valvular dysfunction. NBTE should be suspected in any stroke patient with a known or suspected malignancy and anticoagulation with unfractionated or low molecular weight heparin should be used in cancer patients with NBTE