Periprocedural Anticoagulation of Patients Undergoing Pericardiocentesis for Cardiac Tamponade Complicating Catheter Ablation of Atrial Fibrillation

Abstract

SummaryAnticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF. (Int Heart J 2015; 56: 56-61)

Cardiac tamponade in COVID‐19 patients: Management and outcomes

“…While the use of therapeutic anticoagulation has been shown to improve prognosis in severe patients with COVID‐19 14 the development of sanguineous cardiac tamponade (as seen in Case 1) may point towards increased risks of therapeutic anticoagulation after initial drainage. However, given the documented benefits of therapeutic anticoagulation in patients with COVID‐19, particularly in patients with elevated D‐dimers, it might be judicious to resume anti‐coagulation 12 hours postoperatively, with a high index of suspicion for rebleeding in case of progressive worsening of hemodynamic status 12,15 16,17 .…”

“…in patients with elevated D-dimers, it might be judicious to resume anti-coagulation 12 hours postoperatively, with a high index of suspicion for rebleeding in case of progressive worsening of hemodynamic status. 12,15 ) The role of NSAIDs in this sub-…”

Rivaroxaban for Periprocedural Anticoagulation Therapy in Japanese Patients Undergoing Catheter Ablation of Paroxysmal Non-Valvular Atrial Fibrillation

“…Our patient with cardiac tamponade had a similar clinical course to the previous study, assessing those with cardiac tamponade complicating catheter ablation of AF under uninterrupted warfarin or low molecular weight heparin. 11) This study has other limitations. As mentioned above, few patients with high CHADS 2 scores or no persistent AF were included in this study, therefore, the safety and feasibility of the periprocedural anticoagulation therapy with rivaroxaban in those with a high risk for thromboembolisms or persistent AF is unclear.…”

Management of cardiac tamponade during catheter-directed thrombolysis of saddle pulmonary embolism: A clinical dilemma

“…This patient also received warfarin for a target INR of 2.0–3.0. [ 10 ] Reversal agents such as protamine sulfate and Vitamin K or prothrombin complex concentrates are commonly used to reverse the effects of heparin and warfarin, respectively, in cardiac perforation cases;[ 6 11 ] however, this approach is not feasible in patients with unresolved saddle PE as it would worsen the hypercoagulable state and cause more clot progression.…”