• J-S Allain, E Paven, B Henriot, N Belhomme, A Le Bot, A Ballerie, and P Jego.
• Department of Internal Medicine and Clinical Immunology, Unité d'Investigation Clinique, Rennes University Hospital, Pontchaillou Hospital, 2, rue Henri-Le-Guilloux, 35 000 Rennes, France; Pole CVM, Paul Broussais General Hospital Center, Saint Malo, France; Clinical Investigation Center of Rennes, National Institute of Health and Scientific Research (CIC-INSERM 1414), Rennes, France. Electronic address: jeansebastien.allain@chu-rennes.fr.
• Rev Med Interne. 2021 Mar 1; 42 (3): 218-222.

IntroductionLibman-Sacks endocarditis is a rare complication of antiphospholipid syndrome. Anti-vitamin K therapy is the standard treatment, although valvular replacement surgery may be required in some severe cases. In the latest EULAR recommendations, it is advised not to use direct oral anticoagulants in the management of antiphospholipid syndrome, especially of high-risk profile.Case ReportWe present a case of a mitral Libman-Sacks endocarditis complicated with multiple strokes occurring in the setting of an antiphospholipid syndrome with triple positive antibody profile in a 63-year-old woman with multiple sclerosis. She was previously treated with apixaban for two years. Tinzaparin followed by prolonged warfarine treatment and two months of hydroxychloroquine resulted in valvular improvement.ConclusionTo our knowledge, this is the first case of Libman-Sacks endocarditis occurring during apixaban therapy in a patient with antiphospholipid syndrome. This severe case highlights the inefficiency of direct oral anticoagulants to prevent thrombotic events in the antiphospholipid syndrome.Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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