Faculty mentor/PI email address
AltimoreD@Deborah.org
Keywords
Libman-Sacks Endocarditis, Non-infective Endocarditis, Nonbacterial Endocarditis, Management, Systemic Lupus Erythematosus, Antiphospholipid Syndrome
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Background: Libman-Sacks endocarditis (LSE) is a nonbacterial thrombotic endocarditis detected in 10-40% of patients with systemic lupus erythematosus (SLE), depending on imaging modality. LSE is strongly associated with antiphospholipid syndrome (APS). The condition significantly increases the risk of cerebrovascular accidents and inpatient mortality compared to SLE without cardiac involvement. Despite these serious complications, optimal management remains uncertain. Objective: To review the current evidence on the pathophysiology and management of LSE. Methods: A literature review was conducted using 12 peer-reviewed articles addressing LSE pathophysiology, clinical outcomes, and treatment strategies. Results: Combination anti-inflammatory and antithrombotic therapy achieved 76% vegetation resolution at 6 months. Warfarin is preferred over direct oral anticoagulants (DOACs) in APS patients, with the TRAPS trial demonstrating a 3% event rate with warfarin versus 19% with rivaroxaban. Anticoagulation alone was sufficient in 76% of patients, and surgery was required in only 24% over 20 years of follow-up. Discussion: Immunosuppressive therapy is primarily directed at controlling underlying SLE and reducing inflammatory valvular injury. Anticoagulation is considered when APS antibodies are present, but the optimal intensity and duration remain uncertain. Whether anticoagulation is needed in LSE without APS remains unanswered. Conclusion: Combination therapy with immunosuppression and anticoagulation appears effective for severe LSE, with warfarin preferred over DOACs in patients with APS. However, evidence remains limited to case series and expert opinion. A multidisciplinary approach to treatment with both immunosuppression and anticoagulation is important in treatment.
Disciplines
Cardiovascular Diseases | Medicine and Health Sciences
Included in
Management of Libman-Sacks Endocarditis: The Role of Anticoagulation and Immunosuppressive Therapy
Background: Libman-Sacks endocarditis (LSE) is a nonbacterial thrombotic endocarditis detected in 10-40% of patients with systemic lupus erythematosus (SLE), depending on imaging modality. LSE is strongly associated with antiphospholipid syndrome (APS). The condition significantly increases the risk of cerebrovascular accidents and inpatient mortality compared to SLE without cardiac involvement. Despite these serious complications, optimal management remains uncertain. Objective: To review the current evidence on the pathophysiology and management of LSE. Methods: A literature review was conducted using 12 peer-reviewed articles addressing LSE pathophysiology, clinical outcomes, and treatment strategies. Results: Combination anti-inflammatory and antithrombotic therapy achieved 76% vegetation resolution at 6 months. Warfarin is preferred over direct oral anticoagulants (DOACs) in APS patients, with the TRAPS trial demonstrating a 3% event rate with warfarin versus 19% with rivaroxaban. Anticoagulation alone was sufficient in 76% of patients, and surgery was required in only 24% over 20 years of follow-up. Discussion: Immunosuppressive therapy is primarily directed at controlling underlying SLE and reducing inflammatory valvular injury. Anticoagulation is considered when APS antibodies are present, but the optimal intensity and duration remain uncertain. Whether anticoagulation is needed in LSE without APS remains unanswered. Conclusion: Combination therapy with immunosuppression and anticoagulation appears effective for severe LSE, with warfarin preferred over DOACs in patients with APS. However, evidence remains limited to case series and expert opinion. A multidisciplinary approach to treatment with both immunosuppression and anticoagulation is important in treatment.