Complications of pericardiocentesis: A clinical synopsis

Kumar, Rajan; Sinha, Archana; Lin, Maggie J.; Uchino, Reina; Butryn, Tracy; OʼMara, Michael Shay; Nanda, Sudip; Shirani, Jamshid; Stawicki, Stanislaw P

doi:10.4103/2229-5151.165007

Cited by 51 publications

(11 citation statements)

References 87 publications

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“…When balancing the increased safety from combining echocardiographic and/or fluoroscopic guidance during percutaneous pericardiocentesis with the increased bleeding risk in thrombocytopenic patients with open surgical procedures, the clinical decision has gradually inclined toward the less-invasive approach without any apparent impact on long-term outcomes. Complication rates in this study were consistent with the low incidences reported in prior image-guided studies in non-thrombocytopenic patients, of anywhere between 4 and 20% (7,(20)(21)(22)(23). The decreased rate of complication we assume is due to using micropuncture technique and both echocardiographic and fluoroscopic guidance, and in comlex cases even triple-guidance with additional ultrasoundguided access.…”

Section: Discussionsupporting

confidence: 90%

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Wilson

Lee

Gill

et al. 2021

Front. Cardiovasc. Med.

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Background: Pericardiocentesis is an important diagnostic and therapeutic tool for cancer-associated pericardial effusion. Limited safety and outcomes data exists regarding the management of malignancy-related pericardial effusion in patients with thrombocytopenia.Objectives: Our study aimed to analyze prognostic factors and overall survival (OS) after pericardiocentesis in thrombocytopenic cancer patients.Methods and Results: A retrospective review of 136 thrombocytopenic cancer patients who underwent primary percutaneous pericardiocentesis was performed. Degree of thrombocytopenia was classified by platelet count recorded on day of pericardiocentesis: 75–149 × 103 cells/μL (41%); 50–74 × 103 cells/μL (10%); 25–49 × 103 cells/μL (24%); <25 × 103 cells/μL (25%). Median OS was 2.6 months and median follow-up was 37.4 months. Kaplan-Meier survival analysis showed significant OS differences among thrombocytopenia severity groups (p = 0.023), and worse OS with platelets <100 vs. ≥100 × 103 cells/μL (p = 0.031). By univariate analysis, thrombocytopenia severity was associated with increased risk of death (HR 0.993; 95% CI 0.989–0.997; p = 0.002). Poor prognostic factors for OS were advanced cancer, malignant effusion, elevated international normalized ratio (INR), quantity of platelet transfusions, and platelet transfusion resistance. However, thrombocytopenia severity became insignificant for OS (p = 0.802), after adjusting for advanced cancer and INR.Conclusions: For patients with malignancy-related large pericardial effusion and thrombocytopenia, pericardiocentesis is a feasible intervention and should be considered due to low complication rates. There is no absolute contraindication to pericardiocentesis in case of hemodynamic instability, even with severe thrombocytopenia.

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Section: Discussionsupporting

confidence: 90%

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Wilson

Lee

Gill

et al. 2021

Front. Cardiovasc. Med.

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“…Determination of signs or symptoms suspicious for cardiac tamponade is critical in the case of effusion findings on echocardiography. Urgent pericardial drainage is recommended in the case of tamponade [ 27 ]. The most common therapeutic option that was offered to patients in our study was pericardiocentesis (63.5%), followed by pericardial window (15.4%).…”

Section: Discussionmentioning

confidence: 99%

Case study-based systematic review of literature on lymphoma-associated cardiac tamponade

Shareef¹,

Eshaq²,

Alshawaf³

et al. 2021

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This study aimed to compile all the relevant studies of patients presenting with pericardial tamponade before or after diagnosis of lymphoma, describe the clinical presentations of patients with lymphoma and cardiac tamponade, and assess the difference in overall survival based on the timing of cardiac tamponade diagnosis. A comprehensive search strategy was conducted in the following databases: PubMed and Cochrane Library, using the following keywords: Lymphoma AND Cardiac Tamponade. The criteria for eligibility included cases with a confirmed diagnosis of lymphoma and cardiac tamponade, human studies, and publications in English language. The statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20. We included 48 research articles ( n = 52 cases) with adequate reporting of measured outcomes. The median age of the patients was 52 (9–94) years. Only 6 patients were noted to have primary cardiac lymphoma, while the majority of cases were considered to have secondary cardiac lymphoma (88.5%). According to the data on the type of lymphoma reported through cytology and immunohistochemistry, 49 patients were diagnosed with non-Hodgkin lymphoma, and of these cases the most common subtype was large B-cell lymphoma (42.9%). Overall, the average duration of illness was 14 ± 23 days. A total of 13 patients had distant heart sounds, 12 cases were noted to be hypotensive, and 13 subjects were found to have increased jugular venous pressure. Our retrospective study demonstrated that most patients presented with pericardial tamponade after lymphoma diagnosis, and those were mostly secondary cardiac lymphoma of the non-Hodgkin type with large B-cell as the most common subtype. Dyspnoea, oedema, and constitutional symptoms were the most common presenting signs. The median overall survival of patients with lymphoma and cardiac tamponade is 4 months, with no significant difference in mortality in the presentation timing before and after the diagnosis of lymphoma.

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“…The true incidence of PDS is unknown: in a large retrospective analysis of 1,164 consecutive pericardiocentesis procedures, PDS was reported in only 1 patient, whereas in other series it has been reported in up to 4.8% ( 4 ). As is evident, this syndrome has no uniform clinical presentation and may be associated with both surgical pericardiostomy and pericardiocentesis, whereas the cause of pericardial effusions and clinical scenarios varies widely ( 5 , 6 ).…”

Section: Discussionmentioning

confidence: 99%

An Overlap Presentation of Pericardial Decompression Syndrome and Stress Cardiomyopathy Following Therapeutic Pericardiocentesis

et al. 2020

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Pericardial decompression syndrome, defined as paradoxical hypotension and pulmonary edema after pericardiocentesis, is a rare complication of pericardiocentesis. Stress cardiomyopathy, caused by excess catecholamine response resulting in left ventricular dysfunction and elevated cardiac enzymes, can overlap with pericardial decompression syndrome, and both might belong to the same spectrum of disease. ( Level of Difficulty: Intermediate. )

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Complications of pericardiocentesis: A clinical synopsis

Cited by 51 publications

References 87 publications

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Case study-based systematic review of literature on lymphoma-associated cardiac tamponade

An Overlap Presentation of Pericardial Decompression Syndrome and Stress Cardiomyopathy Following Therapeutic Pericardiocentesis

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