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Nasir SA, Babu Pokhrel N, Baig A. Hemorrhagic Pericardial Effusion From Apixaban Use: Case Report and Literature Review. Cureus 2022; 14:e30021. [DOI: 10.7759/cureus.30021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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Hemopericardium in the setting of direct oral anticoagulant use: An updated systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:73-83. [PMID: 34607787 DOI: 10.1016/j.carrev.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Spontaneous hemopericardium, associated with direct oral anticoagulant (DOAC) use, is one of the uncommon complications with high morbidity that has not been extensively studied We aimed to determine demographic characteristics, clinical features, lab evaluation, management, and outcomes of the studies focusing on hemopericardium as a DOAC use. METHODS PubMed, Web of Science, Google Scholar, and CINAHL databases were searched for relevant articles using MeSH key-words and imported into referencing/review software. The data regarding demographics, clinical characteristics, cardiac investigations, and management were analyzed in IBM Statistics SPSS 21. t-Test and Chi-square test were used. A P score of <0.05 was considered statistically significant. RESULTS After literature search, a total of 41 articles were selected for analysis. The mean age of the patients was 70.09 ± 11.06 years (p < 0.05); the majority of them were males (58.5%). Most of the patients presented with shortness of breath (75.2%) and had more than 3 co-morbid conditions (43.9%). The most frequently used anticoagulant was rivaroxaban (15/41; 36.6%); the common indication being arrhythmia (78.0%). CYP4503A4/P-Gp inhibitors (22.2%) were commonly used by the patients. Majority of the cases had a favorable outcome (95.1%). Pericardial tamponade was noted in 31/41 cases. Pericardiocentesis was performed in 37/41 cases. CONCLUSIONS Hemopericardium from DOAC use has a favorable outcome but requires urgent pericardiocentesis. However, long term mortality, monitoring of DOAC activity, and drug-drug interactions have not been widely studied.
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Bauer C, Furthner D, Grohmann E, Tulzer G. Vitamin K deficiency-induced spontaneous haemopericardium and cardiac tamponade in an infant with alpha-1 antitrypsin deficiency: a case report. Eur Heart J Case Rep 2021; 5:ytaa481. [PMID: 33644648 PMCID: PMC7898583 DOI: 10.1093/ehjcr/ytaa481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/16/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
Abstract
Background Vitamin K deficiency bleeding is a life-threatening complication in early infancy. Exclusive breastfeeding and neonatal cholestasis syndromes, most notable α-1-antitrypsin deficiency, have been reported to be risk factors. Intracranial haemorrhage is most common. No association to haemopericardium has been reported before. Case summary We report on an 11 weeks old at term-born infant, who presented with severe anaemia and signs of cardiogenic shock. Immediately echocardiography was done and depicted cardiac tamponade. Pericardiocentesis was performed and a significant amount of haemorrhagic fluid was removed. Further workup revealed deranged coagulation parameters, cholestatic liver disease, and reduced α-1-antitrypsin levels. Despite normal brain sonography, a small cerebral haemorrhage was detected on magnetic resonance imaging. A genetic test finally proofed homozygotic mutation of the SERPINA1-gene and confirmed the diagnosis of α-1-antitrypsin deficiency as the underlaying cause. After initial replacement of coagulation factors, erythrocytes and vitamin K, the infant recovered. Eighteen weeks after discharge, the infant is still on vitamin K supplementation. She did not have any further bleedings and no neurologic or developmental impairment. Discussion Alpha-1-antitrypsin deficiency can lead to vitamin K deficiency in young infants even with adequate prophylaxis. Spontaneous haemorrhagic pericardial effusion was a new manifestation of vitamin K deficiency bleeding in our patient and should be considered and ruled out in young infants who present with acute anaemia and poor clinical condition.
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Affiliation(s)
- Christoph Bauer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Krankenhausstrasse 26-30, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria
| | - Désirée Furthner
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital GmbH, Krankenhausstrasse 26-30, 4020 Linz, Austria
| | - Eva Grohmann
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Krankenhausstrasse 26-30, 4020 Linz, Austria
| | - Gerald Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Krankenhausstrasse 26-30, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 68, 4040 Linz, Austria
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Xu X, Meng X, Ma F. Delayed cardiac tamponade following catheter ablation of frequent premature ventricular complexes: a case report. BMC Cardiovasc Disord 2020; 20:359. [PMID: 32758134 PMCID: PMC7404917 DOI: 10.1186/s12872-020-01642-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/05/2022] Open
Abstract
Background Cardiac tamponade is a potentially fatal complication after catheter ablation of ventricular arrhythmias. It often happens during or shortly after the procedure and needs urgent treatment. Here, we present a very incredible case about delayed cardiac tamponade after ablation of premature ventricular complexes. Case presentation A 66-year-old woman who underwent successful catheter ablation of right ventricular outflow tract origin premature ventricular complexes. Nineteen days after ablation, the patient experienced sudden syncope. Upon arriving at our hospital, she was “confused and shock”. Transthoracic echocardiography revealed hemorrhagic cardiac tamponade, which was considered due to a delayed tiny perforation in the heart induced by the previous ablation. Following an emergent pericardiocentesis to drain a 200 mL hemorrhagic effusion, the patient’s hemodynamics improved significantly. The patient was discharged after a 2-week hospitalization for investigating other probable causes with negative results. No signs of pericardial effusion recurred in a follow-up time of 12 months. Conclusion This case report demonstrated, for the first time, that very late post-procedural cardiac tamponade might occur after catheter ablation of ventricular arrhythmias, even without antithrombotic treatment.
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Affiliation(s)
- Xiaoyong Xu
- Department of Cardiovascular Disease, Ningbo Medical Treatment Centre Li Huili Hospital, No.57 Xingning Road, Ningbo, 315040, Zhejiang, China
| | - Xianghong Meng
- Department of Medical Technology, Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Fusheng Ma
- Department of Cardiovascular Disease, Ningbo Medical Treatment Centre Li Huili Hospital, No.57 Xingning Road, Ningbo, 315040, Zhejiang, China.
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Adar A, Onalan O, Cakan F. Uma Combinação Fatal: Indometacina e Dabigatrana. Arq Bras Cardiol 2020; 114:13-15. [PMID: 32428110 PMCID: PMC8149119 DOI: 10.36660/abc.20180159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/13/2019] [Indexed: 12/29/2022] Open
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Ioppolo AM, Longobardo L, D'Isa S, De Gregorio P, Manfredi M, De Cesare NB. An Uncommon Case of Spontaneous Hemopericardium in a Patient Treated with Rivaroxaban. J Cardiovasc Echogr 2020; 29:180-182. [PMID: 32090001 PMCID: PMC7011493 DOI: 10.4103/jcecho.jcecho_57_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We describe a case of an 88-year-old woman with a severe bluntly ematic pericardial effusion. Radiological and laboratory examinations excluded all the most common causes of hemopericardium, and the diagnosis of spontaneous hemopericardium associated with the treatment with rivaroxaban was made. This is the first case report describing a hemopericardium in a patient treated with rivaroxaban who did not take other herbal products or drugs that may significantly increase rivaroxaban blood levels. This report emphasizes the need for the careful use of new oral anticoagulants, and the importance of taking in mind uncommon side effects. Spontaneous hemopericardium should be considered in these patients.
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Affiliation(s)
- Anna Maria Ioppolo
- Department of Clinical and Experimental Medicine, Section of Cardiology, Policlinico San Marco, Corso Europa, Zingonia BG, Messina, Italy
| | - Luca Longobardo
- Department of Clinical and Experimental Medicine - Section of Cardiology, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Salvatore D'Isa
- Department of Clinical and Experimental Medicine, Section of Cardiology, Policlinico San Marco, Corso Europa, Zingonia BG, Messina, Italy
| | - Paola De Gregorio
- Department of Clinical and Experimental Medicine, Section of Cardiology, Policlinico San Marco, Corso Europa, Zingonia BG, Messina, Italy
| | - Mariella Manfredi
- Department of Clinical and Experimental Medicine, Section of Cardiology, Policlinico San Marco, Corso Europa, Zingonia BG, Messina, Italy
| | - Nicoletta Bianca De Cesare
- Department of Clinical and Experimental Medicine, Section of Cardiology, Policlinico San Marco, Corso Europa, Zingonia BG, Messina, Italy
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Lin S, Wang Y, Zhang L, Guan W. Dabigatran must be used carefully: literature review and recommendations for management of adverse events. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1527-1533. [PMID: 31190734 PMCID: PMC6511609 DOI: 10.2147/dddt.s203112] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
Atrial fibrillation increases the risk of stroke and death. The vitamin-K antagonist warfarin is recommended for patients with atrial fibrillation, but vitamin-K antagonists are cumbersome to use. Therefore, an effective, safe and convenient new anticoagulant is needed. Dabigatran acts by inhibiting free and fibrin-bound thrombin directly. It is an oral anticoagulant that was approved by the US Food and Drug Administration. The oral anticoagulant dabigatran has been used increasingly due to its good tolerance, predictable pharmacokinetics, effective anticoagulant effects, and absence of requirement of coagulation monitoring. However, an increasing prevalence of adverse events has been reported, some of them quite serious. Therefore, we searched and reviewed the literature on dabigatran with regard to adverse events, and proposed solutions to prevent and reduce the chance of adverse events occurring.
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Affiliation(s)
- Shan Lin
- Department of Respiratory Medicine, Qinghai University Affiliated Hospital, Xining 810001, People's Republic of China
| | - Yan Wang
- Department of Respiratory Medicine, Qinghai University Affiliated Hospital, Xining 810001, People's Republic of China
| | - Lei Zhang
- Department of Respiratory Medicine, Qinghai University Affiliated Hospital, Xining 810001, People's Republic of China
| | - Wei Guan
- Department of Respiratory Medicine, Qinghai University Affiliated Hospital, Xining 810001, People's Republic of China
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Asad ZUA, Ijaz SH, Chaudhary AMD, Khan SU, Pakala A. Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and Systematic Review of Literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:15-20. [PMID: 31088720 DOI: 10.1016/j.carrev.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hemorrhagic cardiac tamponade (HCT) is characterized by rapid accumulation of blood in the pericardium causing hemodynamic collapse. We report a case of HCT due to Apixaban use in a patient with renal cell carcinoma, supplemented with a systematic review of pericardial tamponade associated with the use of direct oral anticoagulants (DOACs). CASE REPORT A 62-year-old African American male with a history of metastatic renal cell carcinoma presented with dyspnea while taking Apixaban. He was diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion was drained. The pericardial fluid analysis was negative for malignancy and suggestive of HCT. He had a complicated hospital course and died several days later. METHODS We searched MEDLINE, EMBASE and other sources for published cases of pericardial tamponade associated with DOACs. Our outcomes of interest included patient characteristics, risk factors, timing from the start of anticoagulation to tamponade, treatment and mortality. Simple descriptive statistics using percentages for categorical variables were used to describe the included cases. RESULTS A total of 26 cases were included in the final systematic review after searching MEDLINE, EMBASE and other sources. The mean age was 70 years (range 43-88) with 19 (73%) males. Twelve cases (46%) were associated with Rivaroxaban, 9 (37%) with Dabigatran and 5(19%) with Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine. Only 2 patients died but 24 had to undergo pericardiocentesis. CONCLUSION Cardiac tamponade is rarely associated with DOACs and elderly male patients with renal and coagulation abnormalities appear to have the highest risk.
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Affiliation(s)
| | | | | | - Safi U Khan
- West Virginia University, Morgantown, WV, USA
| | - Aneesh Pakala
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
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