Recurrence of ischemic stroke on direct oral anticoagulant therapy in a patient with marantic endocarditis related to lung cancer.

ABSTRACT

Venous thromboembolism (VTE) and arterial thromboembolism (ATE) are frequent complications in cancer patients. For curative treatment of VTE in a neoplastic context, recent randomized controlled trials and meta-analyses suggest that direct oral anticoagulants (DOACs) can be an alternative to conventional treatment by low molecular weight heparins (LMWHs). On the other hand, the role of DOACs in the treatment of cancer-related ATE remains unclear. Here, we report a case of stroke recurrence in a patient initially treated with DOACs that were started for cancer-related VTE. The failure of the DOACs, compared to LMWHs, to prevent the stroke recurrence led us to the infrequent final diagnosis of nonbacterial thrombotic endocarditis (formerly known as marantic endocarditis). This case illustrates the association between ATE and VTE in a patient with marantic endocarditis related to lung cancer and recurrence of ischemic stroke on direct oral anticoagulant therapy. <Learning objective: Arterial (ATE) and venous thromboembolism (VTE) are frequent complications in cancer patients. ATE and VTE can be responsible for ischemic stroke in neoplastic context. VTE-associated stroke in cancer patients does not exclude ATE etiology (marantic endocarditis). Direct oral anticoagulants fail to prevent ischemic stroke associated with marantic endocarditis.>.