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The Oncologist, Vol. 12, No. 5, 518-523, May 2007; doi:10.1634/theoncologist.12-5-518
© 2007 AlphaMed Press

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The Community Oncologist

Nonbacterial Thrombotic Endocarditis in Cancer Patients: Pathogenesis, Diagnosis, and Treatment

Khaled el-Shami, Elizabeth Griffiths, Michael Streiff

The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence: Khaled el-Shami, M.D., Ph.D., The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Bunting-Blaustein Cancer Research Building, 1650 Orleans Street, Baltimore, Maryland 21231, USA. Telephone: 410-955-8893; Fax: 410-955-8587; e-mail: kelsham1{at}jhmi.edu

Thrombophilia is a well-described consequence of cancer and its treatment. The pathogenesis of this phenomenon is complex and multifactorial. Nonbacterial thrombotic endocarditis (NBTE) is a serious and potentially underdiagnosed manifestation of this prothrombotic state that can cause substantial morbidity in affected patients, most notably recurrent or multiple ischemic cerebrovascular strokes. Diagnosis of NBTE requires a high degree of clinical suspicion as well as the judicious use of two-dimensional echocardiography to document the presence of valvular thrombi. In the absence of contraindications to therapy, treatment consists of systemic anticoagulation, which may ameliorate symptoms and prevent further thromboembolic episodes, as well as control of the underlying malignancy whenever possible.

Disclosure of potential conflicts of interest is found at the end of this article.






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