Native Aortic Valve Thrombosis in Suspected Antiphospholipid Syndrome

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Native aortic valve thrombosis and suspected high-risk antiphospholipid syndrome (n=1). Intervention: Triple-positive antiphospholipid syndrome on rivaroxaban therapy. Primary outcome: Extensive native aortic valve thrombosis involving all 3 cusps.

Q: What does this research mean for the field?

High-risk antiphospholipid syndrome can manifest as extensive native aortic valve thrombosis across all three cusps despite rivaroxaban anticoagulation therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hassaan Abid; Ahmad Yessin; Jonathon Kissick; Mansour Almnajam; Saleb Karim

doi:10.1016/j.case.2026.10.002

November 1, 2026CASEOpen Access

Native Aortic Valve Thrombosis in Suspected Antiphospholipid Syndrome

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Key result

Triple-positive antiphospholipid syndrome on rivaroxaban presents with extensive native aortic valve thrombosis across all three cusps.

n=1

Why the study?

Native aortic valve thrombosis is an uncommon source of systemic thromboembolism that presents a diagnostic challenge because of overlap with infective endocarditis, nonbacterial thrombotic endocarditis, and other valvular masses.

Key Points

To describe an uncommon presentation of native aortic valve thrombosis mimicking other cardiac masses in a patient with high-risk antiphospholipid syndrome.
Clinical and echocardiographic evaluation of a single patient with recurrent arterial and venous thromboembolism occurring during rivaroxaban therapy.
Comprehensive diagnostic workup including serological testing for triple-positive antiphospholipid antibodies to assess high-risk antiphospholipid syndrome.
Echocardiography revealed extensive thrombosis involving all three cusps of the native aortic valve, with the noncoronary cusp being predominantly affected.
Laboratory testing confirmed triple-positive antiphospholipid antibodies, demonstrating breakthrough systemic thromboembolism on direct oral anticoagulant therapy.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 patient with recurrent arterial and venous thromboembolism despite rivaroxaban therapy and triple-positive antiphospholipid antibody testing suggestive of high-risk APS.

This case report highlights the risk of extensive native aortic valve thrombosis and recurrent thromboembolism despite rivaroxaban therapy in a patient with suspected high-risk triple-positive antiphospholipid syndrome.

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Implication

Valve thrombosis may occur in high-risk APS on rivaroxaban; leaves open optimal anticoagulation and diagnostic differentiation of valvular masses.

Abstract

Native aortic valve (AoV) thrombosis is an uncommon but clinically important source of systemic thromboembolism.1,2 Its presentation as a valvular mass can create a diagnostic challenge because of overlap with infective endocarditis, nonbacterial thrombotic endocarditis (NBTE), and other valvular masses. We report extensive native AoV thrombosis involving all 3 cusps, with predominant involvement of the noncoronary cusp (NCC), in a patient with recurrent arterial and venous thromboembolism despite rivaroxaban therapy and triple-positive antiphospholipid antibody testing strongly suggestive of high-risk antiphospholipid syndrome (APS).

Discussion

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Cite This Study

Abid et al. (2026) conducted a case report in Native aortic valve thrombosis and suspected high-risk antiphospholipid syndrome (n=1). Triple-positive antiphospholipid syndrome on rivaroxaban therapy was evaluated on Extensive native aortic valve thrombosis involving all 3 cusps. Suspected triple-positive antiphospholipid syndrome on rivaroxaban presented with extensive native aortic valve thrombosis involving all 3 cusps in 1 patient with recurrent thromboembolism.

synapsesocial.com/papers/6af88c410e4d8f4b089c1b30 https://doi.org/10.1016/j.case.2026.10.002

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Native Aortic Valve Thrombosis in Suspected Antiphospholipid Syndrome

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Native Aortic Valve Thrombosis in Suspected Antiphospholipid Syndrome

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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