Abstract Details

Title Stroke Characteristics, Management, and Outcomes in Patients with Non-bacterial Thrombotic Endocarditis: A Systematic Review

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-019

Objective

This systematic review summarizes stroke presentation, imaging features, management, and outcomes in patients with NBTE-related stroke.

Background Stroke is a frequent manifestation of non-bacterial thrombotic endocarditis (NBTE), yet current knowledge largely stems from case reports and small case series

Design/Methods We searched PubMed, MEDLINE, Web of Science and PsycINFO databases through August 2025 for studies reporting individual cases or case series of NBTE-related stroke. Extracted data included demographics, vascular risk factors, stroke presentation, imaging features, NBTE etiology, treatment (unfractionated heparin/low molecular weight heparin (UFH/LMWH), warfarin, direct oral anticoagulants (DAOCs), and/or valvular surgeries), and treatment outcomes. Multivariate regression was used to identify predictors of recurrent stroke and mortality.

Results We included 163 patients from 149 studies (median age 56 [IQR:46-64], 60% females). Right (26%) and left (25%) hemispheric stroke syndromes predominated clinical presentation, and multi-territory ischemic infarcts (>2 territories) in 66%. Conventional vascular risk factors were infrequent (1%-23%), whereas deep vein thrombosis (58%) and systemic embolism (40%) frequently preceded or coincided with stroke onset. Malignancy (73%) and autoimmune diseases (21%) were the main NBTE etiologies. Anticoagulation was initiated in 69% and 21% underwent valvular surgery. Over a median follow-up of 1.5 months, stroke recurred in 45% and death in 47% of patients. Malignancy (OR 34.5, P<0.001) and metastases (OR 5.5, P<0.001) significantly increased mortality risk, while UFH/LMWH (OR 0.3, P=0.006), VKA (OR 0.1, P<0.001) and autoimmune etiology (OR 0.2, P=0.029) were associated with decreased mortality. Malignancy (OR 6.8, P=0.009) and DOAC use (OR 8.4, P=0.013) were linked to recurrent stroke in this patient population.

Conclusions NBTE should be considered in stroke patients lacking conventional risk factors, particularly those with underlying malignancy or autoimmune disease. Malignancy and DOAC use may increase the risk of recurrent strokes in this patient population.

Authors/Disclosures
Ahmed Aljabali (Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.) PRESENTER	Ahmed Aljabali has nothing to disclose.
Hallie K. Taylor, DO (Hallie Taylor)	Dr. Taylor has nothing to disclose.
Todd Laffaye	Mr. Laffaye has nothing to disclose.
Majd Al-Ahmad, MD	Dr. Al-Ahmad has nothing to disclose.
Ayham Harahsheh (Islamic Hospital)	No disclosure on file
Mohammad N. Alamoush, Sr., MD	Mr. Alamoush has nothing to disclose.
Khaled Dweik, MD	Dr. Dweik has nothing to disclose.
Mayowa Osundiji, MBBS, PhD	Dr. Osundiji has nothing to disclose.
Amir A. Mbonde, MD (Mayo Clinic Arizona)	Dr. Mbonde has nothing to disclose.
Cumara B. O'Carroll, MD, FAAN (Mayo Clinic)	Dr. O'Carroll has nothing to disclose.
Bart Demaerschalk, MD, MSc, FRCPC, FAAN (Mayo Clinic)	Dr. Demaerschalk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Demaerschalk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Demaerschalk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurologist . The institution of Dr. Demaerschalk has received research support from NICHD.
Ehab Y. Harahsheh, MBBS	Dr. Harahsheh has nothing to disclose.

��ɫ��

��ɫ��