Libman-Sacks endocarditis under apixaban in a patient with a high-risk profile venous antiphospholipid syndrome

Une endocardite de Libman-Sacks survenant sous apixaban chez une patiente atteinte de SAPL veineux de profil à haut risque

J-S Allain (1, 2, 3) , E Paven (1) , B Henriot (3) , N Belhomme (1, 2) , A Le Bot (1) , A Ballerie (4, 1) , P Jego (4, 1, 2)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 CH de Saint-Malo [Broussais]
4 Irset - Institut de recherche en santé, environnement et travail

INTRODUCTION: Libman-Sacks endocarditis is a rare complication of antiphospholipid syndrome. Anti-vitamin K therapy is the standard treatment, although valvular replacement surgery may be required in some severe cases. In the latest EULAR recommendations, it is advised not to use direct oral anticoagulants in the management of antiphospholipid syndrome, especially of high-risk profile. CASE REPORT: We present a case of a mitral Libman-Sacks endocarditis complicated with multiple strokes occurring in the setting of an antiphospholipid syndrome with triple positive antibody profile in a 63-year-old woman with multiple sclerosis. She was previously treated with apixaban for two years. Tinzaparin followed by prolonged warfarine treatment and two months of hydroxychloroquine resulted in valvular improvement. CONCLUSION: To our knowledge, this is the first case of Libman-Sacks endocarditis occurring during apixaban therapy in a patient with antiphospholipid syndrome. This severe case highlights the inefficiency of direct oral anticoagulants to prevent thrombotic events in the antiphospholipid syndrome.

Mots clés: Anticoagulant therapy; Antiphospholipid syndrome; Libman-Sacks endocarditis; Non-bacterial thrombotic endocarditis

Mots clés: Endocardite de Libman-Sacks; Endocardite thrombotique non bactérienne; Syndrome des antiphospholipides; Traitement anticoagulant

Domaines: Sciences du Vivant [q-bio]

J-S Allain, E Paven, B Henriot, N Belhomme, A Le Bot, et al.. Une endocardite de Libman-Sacks survenant sous apixaban chez une patiente atteinte de SAPL veineux de profil à haut risque. La Revue de Médecine Interne, 2021, 42 (3), pp.218-222. ⟨10.1016/j.revmed.2020.08.009⟩. ⟨hal-03000956⟩