# Nonbacterial Thrombotic Endocarditis and Mechanical Valve Thrombosis in a Patient with Antiphospholipid Syndrome

## TL;DR

A rare case of nonbacterial endocarditis in a patient with antiphospholipid syndrome was successfully treated with low-dose tPA and improved anticoagulation.

## Contribution

Demonstrates successful treatment of mechanical valve thrombosis in APS using low-dose tPA and enhanced anticoagulation.

## Key findings

- Low-dose tPA effectively treated valve thrombosis without bleeding.
- Enhanced anticoagulation (INR 3-4) prevented recurrence.
- Fibrinolytic therapy avoided high-risk surgery in APS patients.

## Abstract

•NBTE causing severe MS is extremely rare (<2% of APS patients).•MVT developed 2 months postop with subtherapeutic INR.•Low-dose tPA successfully treated valve thrombosis without bleeding complications.•Enhanced anticoagulation strategy (INR 3-4) prevented recurrent thrombosis.•Fibrinolytic therapy avoided high-risk redo cardiac surgery in APS patient.

NBTE causing severe MS is extremely rare (<2% of APS patients).

MVT developed 2 months postop with subtherapeutic INR.

Low-dose tPA successfully treated valve thrombosis without bleeding complications.

Enhanced anticoagulation strategy (INR 3-4) prevented recurrent thrombosis.

Fibrinolytic therapy avoided high-risk redo cardiac surgery in APS patient.