A case of pulmonary embolism and non bacterial thrombotic endocarditis after chemotherapy to pancreatic cancer

Abstract

Background: The incidence of venous thromboembolism(VTE) in cancer patients is high and has been increasing. VTEs affect patients' quality of lives and sometimes can be the cause of death. Heparin is thought to be more effective than other anticoagulants, and few evidence particularly in cancer patients have clearly shown effectiveness of DOACs, which are much easier to be given. Now we report a case of pancreatic cancer, in which pulmonary embolism(PE) and non-bacterial thrombotic endocarditis(NBTE) simultaneously occurred during DOAC therapy after withdrawal from chemotherapy. Case A woman in her eighties, who had pancreatic cancer with multiple liver metastases, underwent chemotherapy with S-1 since April 201X. US showed a thrombosis in central soleal vein of her left lower limb, and she started treatment with edoxaban 30mg a day. CT scan in October demonstrated progression of the cancer, and chemotherapy were discontinued on November 21st. She was admitted on December 29th, and chest back pain and signs of hypoxemia revealed on December 30th. CT scan showed PE and ultrasound cardiography showed moderate pulmonary hypertension and signs of NBTE with moderate aortic valve regurgitation. Unfractionated heparin(UFH) treatment gradually improved pain and hypoxemia, without recurrence of VTEs until her death of pancreatic cancer on February 21st 201X+1. Conclusion: We experienced a case of PE and NBTE in pancreatic cancer patient, which is refractory to edoxaban, and UFH treatment was thought to be successful.