BACKGROUND Pericardial effusion (PE) is common in cancer patients but the optimal therapeutic approach is not well defined. Percutaneous pericardiocentesis is less invasive than surgery, but its long-term effectiveness and safety are not well documented. OBJECTIVES We evaluated outcomes of cancer patients undergoing percutaneous pericardiocentesis for PE and assessed the procedure’s safety in patients with thrombocytopenia. METHODS Cancer patients who underwent percutaneous pericardiocentesis for PE between November 2009 and October 2014 at MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed. RESULTS Of 1,645 cancer patients referred for PE, 212 (13%) underwent percutaneous pericardiocentesis. The procedure was successful in 99% of the cases with no procedure-related deaths. Four patients had major procedure-related bleeding that did not vary by platelet count <50,000/µl or ≥50,000/µl (p = 0.1281). Patients with catheter drainage for 3 to 5 days had the lowest recurrence rate (10%). Median overall survival was 143 days with age >65 years, lung cancer, platelet count <20,000/µl, and malignant pericardial fluid independently associated with poor prognosis. Lung cancer patients with proven malignant effusions had a significantly shorter median 1-year survival compared to those with nonmalignant effusions (16.2% vs. 49.0%, respectively; log-rank test p value = 0.0101). A similar difference in 1-year survival was not observed in breast cancer patients (40.2% vs. 40.0%, respectively; log-rank test p = 0.4170). CONCLUSION Percutaneous pericardiocentesis with extended catheter drainage, as primary treatment for PE in cancer patients, is safe and effective, including in those with thrombocytopenia. Malignant PE significantly shortens the survival outcome of lung, but not breast, cancer patients.

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Aspirin is one of the most widely used medications across the global healthcare system and is the foundation in treating ischemic heart disease, as well as secondary prevention for ischemic and valvular heart disease. Challenges arise in treating patients with cardiovascular disease who have concomitant aspirin intolerance. Through an extensive review of the literature, we provide a comprehensive background on the pharmacology of aspirin, the mechanisms behind aspirin intolerance, the importance of aspirin in cardiovascular disease, and the management of aspirin intolerance in both acute coronary syndrome and stable coronary artery disease. Our review includes a multidisciplinary approach from the internist, allergist/ immunologist, and cardiologist when evaluating this important patient population.

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Objectives: We evaluated outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion and assessed the procedure’s safety in patients with thrombocytopenia. Background: Pericardial effusion is common in cancer patients. The optimal therapeutic approach is not well defined and in practice depends on patient characteristics and local hospital expertise. Percutaneous pericardiocentesis is less invasive than surgery, but its effectiveness and safety are not well documented. Methods: Cancer patients who underwent percutaneous pericardiocentesis for pericardial effusion between November 2009 and October 2014 at MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed. Results: Of 1645 cancer patients referred for pericardial effusion, 212 (13%) underwent percutaneous pericardiocentesis; procedure was successful in 99% of the cases, and there were no procedure-related deaths. Four patients had major procedure-related bleeding necessitating blood transfusions and/or surgical intervention. Procedure-related bleeding did not differ between patients with normal platelet counts and thrombocytopenic patients. Effusion recurred in 26 (12%) patients. Patients with catheter drainage for 3-5 days had the lowest recurrence rate (10%). Median overall survival was 143 days (95% CI, 95-221). Age>65 years, lung cancer, platelet count <20,000/μL, and malignant pericardial fluid were independently associated with poor prognosis. In lung cancer, but not breast cancer, median survival was shorter in patients with malignant effusions than in those with nonmalignant effusions. Conclusion: Percutaneous pericardiocentesis with extended catheter drainage, as primary treatment for pericardial effusion in cancer patients, is safe and effective, including in those with thrombocytopenia. Malignant pericardial effusion significantly shortens the survival outcome of lung cancer patients, but not breast cancer patients.

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