Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature

Ertaş, Faruk; Polat, Nihat; Yıldız, Abdulkadir; Oylumlu, Mustafa; Ülgen, Mehmet Sıddık

doi:10.5799/ahinjs.01.2013.02.0273

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…VTE treatment decisions and ongoing management can be complex due to the risks of bleeding and recurrence of thrombosis. There have been several reports of observed hemopericardium in patients taking DOACs [5, 6, 11, 13]. To our knowledge, this is amongst the few case reports of the complication of spontaneous hemopericardium occurring in a patient on apixaban and the first in a patient with known history of malignancy and autoimmune disease.…”

Section: Discussionmentioning

confidence: 87%

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Spontaneous Hemorrhagic Pericardial and Pleural Effusion in a Patient Receiving Apixaban

et al. 2019

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Direct oral anticoagulants (DOACs) are used for many conditions where anticoagulation is needed such as non-valvular atrial fibrillation, deep vein thrombosis (DVT) and pulmonary embolism (PE). These novel agents have become popular since they do not require monitoring of therapeutic levels and there is a lower risk of certain bleeding complications when compared to warfarin. However, the efficacy and side effect profile of these agents have not been widely studied in certain patient cohorts, namely cancer patients and patients on immunomodulators or hormone analogs. We present a case of a patient with a history of malignancy and autoimmune disease who developed pericardial and pleural effusions shortly after initiating apixaban for treatment of a PE. In addition, we aim to increase awareness of the role that the newly available reversal agents for anticoagulants would offer in the acute management of hemorrhagic pericardial and pleural effusions caused by DOACs in patients with and without malignancy.

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Section: Discussionmentioning

confidence: 87%

“…Anticoagulants are known to be associated with significant bleeding events. There have been previous case reports of hemopericardium occurring in patients taking warfarin and DOACs [8-11]. As previously mentioned, hemopericardium can also be caused by malignancy.…”

Section: Discussionmentioning

confidence: 96%

Spontaneous Hemorrhagic Pericardial and Pleural Effusion in a Patient Receiving Apixaban

et al. 2019

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“…Ancak bu grupta olguların yaklaşık yarısı kapak ameliyatı geçirdiği için warfarin kullanma öyküsü vardı ve dolayısıyla dren alındıktan sonra INR değerlerinin düzenlenmesi gibi nedenlerden daha uzun yattıkla-rını düşünmekteyiz. Kapak cerrahisi sonrası warfarin kullanımına bağlı perikardiyal efüzyon gelişen hastalarda öncelikle perikardiyosentez yapılması tercih edilmektedir [20]. Serimizde kapak cerrahisi sonrası perikardiyal efüzyon nedeniyle tedavi edilen toplam 10 hasta vardı.…”

Section: Sağkalım Analiziunclassified

“…Diğer taraftan önceki çalışmamızda minitorakotomiyi obezlerde, memesi büyük olan kadınlarda, önceden mastektomi geçirmiş veya gö-ğüs radyoterapisi almış olanlarda yapmamak gerektiği tecrübesine sahip olduğumuzdan doğru vaka seçimininde ameliyat süresinin anlamlı kısa olmasın-da etkili olduğunu düşünmekteyiz. Aynı çalışmada, nüks oranının düşük olduğunu(%2.08) ve işlemle ilgili mortalite olmadığını, ancak bu metodu obezlerde, iri göğüslü kadınlarda uygulamanın morbidite ve hastane mortalitesini artırdığını tespit etmiştik [20]. Postoperatif fazla ağrı sorununu ise günümü-zün modern ağrı önleme yöntemleri artık çözmek-tedir.…”

Section: Sağkalım Analiziunclassified

The efficacy of VATS, subxiphoid and minithoracotomy pericardial window for surgical management of symptomatic pericardial effusions

Çelık¹,

Aydemir²,

Uncu³

et al. 2014

Diclemedj

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“…Cardiac tamponade secondary to haemopericardium is rarely seen and occurs with traumatic and non-traumatic causes. Non-traumatic causes are less common and associated with a number of conditions such as malignancy, infection, uraemia or coagulopathy (2). Today, warfarin sodium is still the most commonly used agent for anticoagulant therapy.…”

mentioning

confidence: 99%

Spontaneous Isolated Pericardial Tamponade Associated with Warfarin

Akgedik¹,

Günaydın²,

Kızılırmak³

et al. 2015

Balkan Med J

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An 83-year-old female patient was admitted to the emergency department with progressive dyspnea and orthopnea for 3 days. She was discharged with warfarin therapy (5 mg per day) due to pulmonary embolism 5 months previously. On admission she was orthopneic and tachypneic. Her arterial blood pressure was 90/60 mmHg and heart rate was 115/min with sinus rhythm. On cardiac auscultation, S1 and S2 intensity were decreased, and pathologic murmur and pericardial friction were not observed. Other physical examination findings were unremarkable. An increased cardio-thoracic ratio was revealed on chest X-ray ( Figure 1a). Decreased QRS voltage and sinus tachycardia was evaluated on electrocardiogram. The internalised normalised ratio (INR) level was 8.6 and the prothrombin time was 70 seconds. Haemoglobin was determined to be 11.1 g/dL. The other laboratory findings were normal. An emergency thoracic computed tomography (CT) scan was performed to exclude recurrent pulmonary embolism, and surprisingly showed a massive pericardial effusion (Figure 1b). However, echocardiography revealed severe pericardial effusion that was compressing the right ventricle. Therefore, vitamin K and fresh frozen plasma infusion were administered promptly. As a result, the INR was decreased to 1.4 and 800 mL haemorrhagic fluid was drained percutaneously (P/S) with the apical approach. The patient's blood pressure, orthopnoea and dyspnoea improved dramatically. There was no other source of bleeding except haemopericardium. Consequently, the cardiac tamponade in our patient, secondary to haemopericardium, was considered to be the result of the incorrect dosage of Warfarin. Spontaneous Isolated Pericardial Tamponade Associated with Warfarin

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Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature

Cited by 4 publications

References 13 publications

Spontaneous Hemorrhagic Pericardial and Pleural Effusion in a Patient Receiving Apixaban

Spontaneous Hemorrhagic Pericardial and Pleural Effusion in a Patient Receiving Apixaban

The efficacy of VATS, subxiphoid and minithoracotomy pericardial window for surgical management of symptomatic pericardial effusions

Spontaneous Isolated Pericardial Tamponade Associated with Warfarin

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