warfarin and Hypereosinophilic-Syndrome

Loeffler endocarditis is a relatively rare and potentially life-threatening heart disease. This study aimed to identify the characteristic features of Loeffler endocarditis with intracardiac thrombus on a background of hypereosinophilic syndrome (HES).. We described a 57-year-old woman with Loeffler endocarditis and intracardiac thrombus initially presenting with neurological symptoms, who had an embolic stroke in the setting of HES. After cardiac magnetic resonance (CMR), corticosteroids and warfarin were administered to control eosinophilia and thrombi, respectively. During a 10-month follow-up, the patient performed relatively well, with no adverse events. We also systematically searched PubMed and Embase for cases of Loeffler endocarditis with intracardiac thrombus published until July 2021. A total of 32 studies were eligible and included in our analysis. Further, 36.4% of recruited patients developed thromboembolic complications, and the mortality rate was relatively high (27.3%). CMR was a powerful noninvasive modality in providing diagnostic and follow-up information in these patients. Steroids were administered in 81.8% of patients, achieving a rapid decrease in the eosinophil count. Also, 69.7% of patients were treated with anticoagulant therapy, and the thrombus was completely resolved in 42.4% of patients. Heart failure and patients not treated with anticoagulation were associated with poor outcomes.. Cardiac involvement in HES, especially Loeffler endocarditis with intracardiac thrombus, carries a pessimistic prognosis and significant mortality. Early steroids and anticoagulation therapy may be beneficial once a working diagnosis is established. Further studies are needed to provide evidence-based evidence for managing this uncommon manifestation of HES.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anticoagulants; Child; Child, Preschool; Embolic Stroke; Female; Heart Diseases; Humans; Hypereosinophilic Syndrome; Male; Middle Aged; Thrombosis; Treatment Outcome; Warfarin; Young Adult

Hypereosinophilic syndrome is a rare entity that can develop secondary to overproduction of eosinophilopoietic cytokines or as idiopathic disease. Cardiac involvement, which occurs often, is divided into 3 stages, the latter of which is nonreversible and leads to severe heart failure. Early detection and treatment of the syndrome is essential. For this reason, genetic testing for the FIP1L1-PDGFRA fusion gene has recently been added to the diagnostic algorithm. Patients with this mutation are at increased risk for the development of cardiac involvement and typically respond to treatment with the tyrosine kinase inhibitor imatinib mesylate.

Topics: Adult; Anticoagulants; Antineoplastic Agents; Bone Marrow Examination; Echocardiography; Heart Failure; Humans; Hypereosinophilic Syndrome; Imatinib Mesylate; Male; mRNA Cleavage and Polyadenylation Factors; Mutation; Oncogene Proteins, Fusion; Prednisone; Receptor, Platelet-Derived Growth Factor alpha; Thrombosis; Treatment Outcome; Warfarin

Topics: Adult; Aphasia; Cerebral Infarction; Early Diagnosis; Echocardiography; Follow-Up Studies; Headache; Humans; Hypereosinophilic Syndrome; Imatinib Mesylate; Magnetic Resonance Imaging; Male; Risk Assessment; Secondary Prevention; Treatment Outcome; Warfarin

Topics: Adult; Anticoagulants; Combined Modality Therapy; Disseminated Intravascular Coagulation; Female; Heparin; Humans; Hypereosinophilic Syndrome; Platelet Transfusion; Portal Vein; Pulmonary Embolism; Radiography; Thrombophlebitis; Ultrasonography; Vena Cava Filters; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Topics: Adrenal Cortex Hormones; Adult; Anticoagulants; Benzamides; Drug Therapy, Combination; Endocarditis; Eosinophils; Heart; Humans; Hypereosinophilic Syndrome; Imatinib Mesylate; Male; mRNA Cleavage and Polyadenylation Factors; Oncogene Proteins, Fusion; Piperazines; Prednisone; Pyrimidines; Receptor, Platelet-Derived Growth Factor alpha; Remission Induction; Thrombosis; Treatment Outcome; Warfarin

Topics: Aged; Anticoagulants; Aortic Diseases; Fatal Outcome; Female; Humans; Hypereosinophilic Syndrome; Thrombosis; Warfarin

A case of endomyocardial fibrosis in a patient with idiopathic hypereosinophilic syndrome is reported and discussed. The authors draw attention to the importance of both echocardiography (two-dimensional and Doppler) and nuclear magnetic resonance in the detection of cardiac involvement due to this rare pathology. Moreover, these imaging techniques appear to be valuable in the evaluation of effects of medical treatment. Therapy with corticosteroids alone has shown no reliable effectiveness in reducing the absolute eosinophil count. A combined immunosuppressive treatment with use of hydroxyurea is required.

Topics: Dipyridamole; Drug Therapy, Combination; Echocardiography, Doppler; Endomyocardial Fibrosis; Female; Humans; Hydroxyurea; Hypereosinophilic Syndrome; Magnetic Resonance Imaging; Middle Aged; Prednisone; Warfarin