Cancer-Associated Nonbacterial Thrombotic Endocarditis: Current Evidence and Clinical Challenges

Mohammed Alkhanafsa¹, Fadel Alqatati¹

Keywords: nonbacterial thrombotic endocarditis, cancer-associated thrombosis, maranticendocarditis, ischemic stroke, adenocarcinoma, anticoagulation, transesophagealechocardiography

DOI: DOI: 10.63475/yjm.v5i2.0436

DOI URL: https://doi.org/DOI: 10.63475/yjm.v5i2.0436

Publish Date: 20-08-2026

Download PDF

Pages: 264 - 273

Views: 1

Downloads: 1

Citation: 0

Author Affiliation:

1 Resident, Department of Medicine, Hamad Medical Corporation, Doha, Qatar

Abstract

Nonbacterial thrombotic endocarditis (NBTE) is an uncommon but clinically important manifestation of cancer-associated thrombosis, characterized by sterile platelet-fibrin vegetations, usually on the mitral or aortic valve. It is most often associated with advanced adenocarcinoma and systemic hypercoagulability and commonly presents through systemic embolization, particularly multifocal ischemic stroke. Diagnosis is challenging because vegetations may be small, blood cultures are typically negative, and findings overlap with infective endocarditis, autoimmune valvulopathy, and degenerative lesions. Transthoracic echocardiography (TTE) is an appropriate initial test, but transesophageal echocardiography (TEE) is substantially more sensitive and should be performed when clinical suspicion remains high despite a negative or nondiagnostic TTE. Cardiac magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography/computed tomography may be useful adjuncts in selected diagnostically uncertain cases. Management is supported predominantly by observational cohorts, case series, and expert opinion rather than randomized NBTE-specific trials. Therapeutic unfractionated heparin or low-molecular-weight heparin is commonly favored when bleeding risk is acceptable, while evidence for direct oral anticoagulants remains limited and mixed. Control of the underlying malignancy is central to reducing recurrent embolic risk. This review summarizes current evidence on pathogenesis, presentation, diagnosis, anticoagulation, prognosis, and research priorities in cancer-associated NBTE.

---