Key result
NBTE is identified in ~38% of cancer-associated strokes and linked to multi-territory embolic infarctions.
Why the study?
No prospective study had examined the prevalence and anticoagulation management of nonbacterial thrombotic endocarditis, a severe manifestation of malignancy-associated hypercoagulability, in patients with acute ischemic stroke.
Observational (n=16)
No
In patients with acute ischemic stroke and active malignancy, NBTE is highly prevalent (37.5%) and associated with multi-territory infarcts, with observational data suggesting LMWH may be more effective than DOACs for vegetation regression.
Answers are grounded in this paper and cite their sources.
NBTE evaluation may warrant consideration in cancer-associated stroke; leaves open optimal anticoagulation strategy pending prospective data.
About 3–10% of patients with acute ischemic stroke (AIS) have active cancer. Malignancy-associated hypercoagulability (MAH) is an established cause of cancer-associated stroke. Nonbacterial thrombotic endocarditis (NBTE) is a severe manifestation of MAH. However, no prospective study has examined its prevalence and anticoagulation management in AIS. We conducted a prospective observational study at a tertiary center including patients with AIS or transient ischemic attack (TIA) and active malignancy. All patients underwent transthoracic echocardiography, followed by transesophageal echocardiography when indicated. Among 3,491 screened patients, 16 with active cancer and AIS/TIA were included. Eleven (68.8%) showed embolic patterns suggestive of MAH, and 6 (37.5%) had NBTE. NBTE patients numerically more frequently had multiterritory embolic infarctions (100% vs. 60.0%, p = 0.102) and prior ischemic stroke (66.7% vs. 10.0%, p = 0.028). 4/6 were on direct oral anticoagulants (DOACs), while none were on low-molecularweight heparin (LMWH). Under LMWH, vegetations resolved or regressed in 3/4, whereas under DOACs, progression or recurrent embolism occurred in several patients. Twelve-month mortality was high in both MAH (90.9%) and NBTE (83.3%) groups. NBTE was frequently identified in this prospective cohort of patients with cancer-associated stroke and consistently associated with multi-territory embolic infarction. Recognition may enable earlier diagnosis. Larger studies are needed to define optimal anticoagulation strategies.
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Frydas et al. (2026) conducted an observational in Acute ischemic stroke or transient ischemic attack with active malignancy (n=16). Nonbacterial thrombotic endocarditis (NBTE) vs. Active malignancy and stroke without NBTE was evaluated on Multi-territory embolic infarction (OR 11.00, 95% CI 0.50-242.36, p=0.102). Nonbacterial thrombotic endocarditis was identified in 37.5% of patients with cancer-associated stroke and was consistently associated with multi-territory embolic infarctions (100% vs 60.0%).
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