Article ID: 11320
A 69-year-old male patient with a history of paroxysmal atrial fibrillation, treated with rivaroxaban, visited the emergency room with complaints of dizziness. A cranial MRI revealed an acute ischemic stroke with hemorrhagic transformation in the region of the right cerebellar hemisphere and vermis. Blood tests were positive for lupus anticoagulant, leading to a diagnosis of antiphospholipid syndrome (APS). Transesophageal echocardiography showed valvular vegetation on the mitral valve, suggesting non-bacterial thrombotic endocarditis (NBTE) associated with APS. Thus, the diagnosis of cardiogenetic embolic cerebellar infarction due to NBTE was made. Due to the patient’s refusal to take warfarin, edoxaban and aspirin, instead of rivaroxaban, were prescribed for secondary stroke prevention. The patient experienced no recurrence of stroke, and follow-up transesophageal echocardiography performed at 130 days after the onset of the stroke showed a shrink in the valvular vegetation. This case suggests that combination therapy with edoxaban and aspirin can be a viable agent for patients with NBTE secondary to APS. Careful monitoring with transesophageal echocardiography is recommended for such cases.
