Hemorrhagic pericarditis with cardiac tamponade after percutaneous coronary intervention associated with the use of abciximab

Moon, Su Jin; Yoon, Hee Jeoung; Her, Sung Ho; Lee, Jong Min; An, Ho Jung; Lee, Yune Jeong; Jin, Seung Won

doi:10.3904/kjim.2008.23.3.156

Cited by 5 publications

(13 citation statements)

References 5 publications

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“…Previously, there have been cases described in the literature of tamponade arising from haemorrhagic pericarditis associated with thrombolysis, usually associated with anterior MI [ 14 ] and more recently with the use of glycoprotein IIb/IIIa inhibitors during PCI [ 13 , 15 ] and combinations thereof [ 16 ]. However, few cases of tamponade attributed to prasugrel-induced haemorrhagic effusions have been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report

Cader

Haq

Nasrin

et al. 2016

BMC Cardiovasc Disord

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BackgroundStriking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks. This risk of bleeding is often underestimated when prescribing pharmacological agents such as DAPT and LMWH, designed to reduce ischaemic events following PCI in acute MI. Life-threatening haemorrhagic pericardial and pleural effusions not associated with access site bleeding are a rare example of such bleeding complications.Case presentationWe report a case of a Bangladeshi male who developed cardiac tamponade resulting from haemorrhagic pericardial effusion as well as bilateral pleural effusions, 9 days after PCI with a DES, while on prasugrel and aspirin. He had presented late with inferior ST elevation myocardial infarction (STEMI), and was therefore also given enoxaparin initially. Haemorrhagic pericardial and pleural fluid were drained, and the patient was discharged on DAPT comprising of aspirin and clopidogrel. Following PCI to obtuse marginal, which was done as a staged procedure 6 months later, he was commenced on ticagrelor instead of clopidogrel. He developed no further bleeding complications over 1 year of follow up.ConclusionNon-access site bleeding such as this, leading to haemorrhagic pericardial and pleural effusions can be rare and life-threatening. Furthermore, patients with acute coronary syndromes (ACS) have marked variation in their risk of major bleeding. Since haemorrhagic complications are associated with mortality, maintaining a balance between the risk of recurrent ischemia and that of bleeding is of paramount importance. The use of validated bleeding risk scores, careful monitoring of patients on DAPT with LMWH, or a switch over to agents with lesser risk of bleeding may reduce such complications.

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Section: Discussionmentioning

confidence: 99%

Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report

Cader

Haq

Nasrin

et al. 2016

BMC Cardiovasc Disord

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“…Comorbidities considered in these patients were widely Diabetes Mellitus [ 32 , 40 , 42 ], hypertension [ 31 , 32 , 37 - 40 , 42 ], CAD [ 31 , 32 , 36 , 37 , 40 ], Prosthetic valve replacement [ 41 ], Liver cirrhosis [ 35 ]. Risk factors include smoking [ 31 , 36 , 38 - 40 ], alcohol use [ 31 , 35 ], and recreational drug use such as cocaine [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

“…In the 13 case reports we reviewed, Abciximab was used in four of them [ 33 , 38 , 39 , 41 ]. Half of the patients had a significant history of smoking and hypertension [ 38 , 39 ].…”

Section: Reviewmentioning

confidence: 99%

“…In the 13 case reports we reviewed, Abciximab was used in four of them [ 33 , 38 , 39 , 41 ]. Half of the patients had a significant history of smoking and hypertension [ 38 , 39 ]. In all the case reports, healthcare providers administered Abciximab during or after percutaneous coronary intervention due to an extensive thrombus burden.…”

Section: Reviewmentioning

confidence: 99%

“…In two cases, a single dose was administered [ 33 , 41 ]. The other two had an initial bolus given, followed by a 12-hour infusion [ 38 , 39 ].…”

Section: Reviewmentioning

confidence: 99%

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Adverse Drug Effect Profiles of Gp2b/3a Inhibitors: A Comparative Review of the Last Two Decades

Hasan,

Jauregui,

Zubair

et al. 2023

Cureus

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ST-Elevation Myocardial Infarction and non-ST Elevation Myocardial Infarction belong to the acute coronary syndrome group of diseases. These conditions are characterized by the complete or partial blockage of one or several coronary arteries, resulting in myocardial injury or necrosis. Various medications are used in their treatment, with the most recent addition being Glycoprotein IIb/IIIa inhibitors. They work by hindering the activity of glycoprotein IIb/IIIa receptors, which, in turn, prevents the clumping of platelets. Some of the GpIIb/IIIa inhibitors available in this category include abciximab, tirofiban, eptifibatide, roxifiban, and orbofiban. With this comprehensive literature review, we aimed to explore the potential adverse effects of these medications and compare the three in terms of their side effects profile. We searched through PubMed and Google Scholar and pinpointed 13 articles aligned with our inclusion criteria: six articles utilized eptifibatide, four were related to abciximab, and three used tirofiban. In 85% of the cases, a severe drop in platelet count, reaching as low as 1000/μL, was reported. Additionally, several other side effects were noted: one case documented multiple bruising spots appearing around the patient's body, two cases reported diffuse alveolar hemorrhage, and one case described a cardiac tamponade resulting from hemorrhagic pericarditis. Our study highlights the crucial significance of keeping a watchful eye on and comprehending the potential drawbacks linked to these medications in cardiovascular treatment. The necessity of researching these medications and their side effects is also evident, as this will significantly enhance the quality of treatment provided.

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Drugs that affect blood coagulation, fibrinolysis, and hemostasis

Aronson¹

2011

Side Effects of Drugs Annual

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Hemorrhagic pericarditis with cardiac tamponade after percutaneous coronary intervention associated with the use of abciximab

Cited by 5 publications

References 5 publications

Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report

Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report

Adverse Drug Effect Profiles of Gp2b/3a Inhibitors: A Comparative Review of the Last Two Decades

Drugs that affect blood coagulation, fibrinolysis, and hemostasis

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