RESUMO
We report a 74-year-old woman with acute heart failure and recurrent ischemic strokes as the presenting features of a nonbacterial thrombotic endocarditis complicating a gastric adenocarcinoma. The treatment only allowed a few months remission. Diagnosis of nonbacterial thrombotic endocarditis is rarely obtained while the patient is alive. Coagulation abnormalities due to the tumoral process are responsible of the valvular thrombotic process. Anticoagulation with heparin is recommended. Valvular surgery remains controversial.
Assuntos
Adenocarcinoma/complicações , Endocardite/etiologia , Neoplasias Gástricas/complicações , Trombose/etiologia , Idoso , Feminino , Insuficiência Cardíaca/complicações , Humanos , Acidente Vascular Cerebral/complicaçõesRESUMO
Venous thromboembolic events are frequent in patients with cancer. Patients on anticoagulant therapy are both at increased risk for subsequent thromboembolic and bleeding events. Whatever the therapeutic option (vitamin K antagonists [VKA] or low-molecular-weight heparin [LMWH]) a clinic and biological monitoring is required. International Normalized Ratio (INR) variability is increased in patients with cancer as compared with patients without cancer and should be maintained in the target range. Anti-Xa activity measurement may be used in LMWH treatments, in order to detect a possible accumulation in any patients; platelet count monitoring is recommended. Interpretation is most often difficult because of numerous possible causes of thrombopenia in the patient with cancer. Anticoagulant clinics are developed in order to help practitioners and participate in the monitoring of anticoagulant treatments in those patients.