Atraumatic hemopericardium in a patient receiving warfarin therapy for a pulmonary embolus

Abstract

Acute pericardial tamponade is a potentially life-threatening condition that requires immediate treatment. This report describes a patient who presented to the emergency department with an acute hemopericardium and echocardiographic evidence of cardiac tamponade following the initiation of warfarin therapy for a recently diagnosed pulmonary embolism. The association between cardiac tamponade, oral anticoagulation and pulmonary thromboembolic disease is briefly discussed.

Preface to the First Issue, JCDR

“…2,3 Most of these cases, which were reported so far, had supra-therapeutic anticoagulation. 4,5 In the RE-LY trial risk of hemopericardium was 0.03% (3 case reports on dabigatran etexilate150 mg BID) 6 .…”

“…Cytological examination of the pericardial fluid revealed no malignant cells and was described as fresh blood. Chemical analysis showed a glucose level of 34 mg/dl, protein 4.6 g/dl, lactate dehydrogenase 300 u/l, red blood cell count greater than 0.1 x 10 6 /mm 3 , and white blood cell count 5.2 x 10 3 / mm 3 (neutrophils 66%, lymphocytes 19%, monocytes 9%, eosinophils 5%, and basophils 1%). Transthoracic echocardiography was performed on hospital day-3 that showed minimal residual pericardial effusion (Figure 3).…”

Hemopericardium and Cardiac Tamponade Associated with Dabigatran Use

“…7 While there is no known literature, and only one published case report 8 outlining the relationship between hemopericardium and dabigatran use, there are a handful of documented cases of warfarininduced hemopericardium. [8][9][10][11] At the time of writing, we identified 10 published case reports of warfarin-induced hemopericardium and cardiac tamponade. [9][10][11] Katis reported a 67-year-old female who presented to the ED in 2005 with sudden new-onset chest pain.…”

“…[8][9][10][11] At the time of writing, we identified 10 published case reports of warfarin-induced hemopericardium and cardiac tamponade. [9][10][11] Katis reported a 67-year-old female who presented to the ED in 2005 with sudden new-onset chest pain. 9 The patient had experienceed a pulmonary embolus 3 weeks prior to presentation, and she had subsequently received anticoagulation therapy with warfarin.…”

“…[9][10][11] Katis reported a 67-year-old female who presented to the ED in 2005 with sudden new-onset chest pain. 9 The patient had experienceed a pulmonary embolus 3 weeks prior to presentation, and she had subsequently received anticoagulation therapy with warfarin. Her INR upon admission was 3.51.…”