Which of the following about Nonbacterial thrombotic endocarditis (NBTE) is false?

Nonbacterial thrombotic endocarditis (NBTE) is characterized by the deposition of sterile thrombi on cardiac valves, typically in those with an underlying hypercoagulable state.  Although NBTE can occur in otherwise healthy individuals, a wide variety of diseases associated with general debility or wasting are associated with an increased risk for NBTE—hence the alternate term marantic endocarditis. In contrast to infective endocarditis, the sterile valvular lesions of NBTE are nondestructive. The vegetations in NBTE are typically small (1 to 5 mm in diameter)  and valvular damage is not a prerequisite. Indeed, the condition usually occurs on previously normal valves. Rather, hypercoagulable states are the usual precursor to NBTE; such conditions include chronic disseminated intravascular coagulation, hyperestrogenic states, and those associated with underlying malignancy, particularly mucinous adenocarcinomas. This last association probably relates to the procoagulant effect of circulating mucin and/or tissue factor elaborated by these tumors. Endocardial trauma, such as from an indwelling catheter, also is a well-recognized predisposing condition. Robbins BASIC  PATHOLOGY T E N T H   E D I T I O N, Page No:428