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Non-bacterial thrombotic endocarditis 

Non-bacterial thrombotic endocarditis
Chapter:
Non-bacterial thrombotic endocarditis
Author(s):

Patrizio Lancellotti

DOI:
10.1093/med/9780198784906.003.0395_update_001

Update:

New reference added in ‘Definition and epidemiology’

Updated on 1 October 2020. The previous version of this content can be found here.
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date: 17 April 2021

Non-bacterial thrombotic endocarditis (NBTE) is characterized by the presence of sterile vegetations on cardiac valves that consist of fibrin and platelet aggregates. These vegetations are neither associated with bacteraemia nor with destructive changes of the underlying valve. The diagnosis of NBTE relies on strong clinical suspicion in the context of (a) a disease process known to be associated with NBTE, (b) the presence of a heart murmur, (c) a negative blood culture, (d) the presence of vegetations not responding to antibiotic treatment, and (e) evidence of multiple systemic emboli. The same initial diagnostic work-up as for infective endocarditis is recommended. Serial blood cultures, exhaustive haematological and coagulation studies, and a comprehensive echocardiography should be performed. The management of NBTE is challenging and a tailored approach should be advocated. It should first focus on the underlying pathology. In the absence of contraindications, an anticoagulation treatment should be given. Surgical intervention is not recommended unless the patient has clear indications (i.e. heart failure due to valve dysfunction).

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