Echocardiography and Fluoroscopy-Guided Pericardiocentesis for Cancer Patients With Cardiac Tamponade and Thrombocytopenia

Iliescu, Cezar; Khair, Tarif; Marmagkiolis, Konstantinos; Iliescu, Gloria; Durand, Jean Bernard

doi:10.1016/j.jacc.2016.05.068

Cited by 16 publications

(9 citation statements)

References 2 publications

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“…There is no platelet count threshold at which the risk of bleeding cannot be accounted for (9), and hemorrhagic complications directly impact survivorship among patients with malignancy (10). Thrombocytopenia often carries prohibitive surgical risk and is a relative contraindication for percutaneous pericardiocentesis (11). Traditional approach included attempts to correct thrombocytopenia with prophylactic platelet transfusion with a platelet count goal >50 × 10 3 cells/µL (12).…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…A prophylactic platelet transfusion is rarely needed and even often unproductive before a pericardial puncture in these patients, however, even with a platelet count below 20,0 0 0 p/mL [23 -25] . Still, it is advisable to carefully use a echocardiography-and fluoroscopy guided parasternal or apical approach for such patients, although in experienced hands a subxiphoidal approach appears to be safe as well [24] .…”

Section: Procedural Considerationsmentioning

confidence: 99%

A contemporary look at pericardiocentesis

Sinnaeve

Adriaenssens

2019

Trends in Cardiovascular Medicine

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Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.

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“…Thrombocytopenia is frequent in cancer patients, occurring in anywhere from 10 to 25% of solid tumor patients treated with intensive chemotherapy as well as most acute leukemia, lymphoma, myelodysplastic syndrome and multiple myeloma patients ( 35 ). Complicating their management, 15 to 25% of thrombocytopenic patients experience thrombocytopenia refractory to platelet transfusion, which is defined as failure to increase platelet counts by 10,000/μl or more after transfusion of an appropriate dose of platelets or >3,000/μl increase per unit ( 36 ). Clinical studies suggest that platelet function is more important than platelet count ( 37 ).…”

Section: Interventional Cardio-oncologymentioning

confidence: 99%

“…TEG is a viscoelastic method of blood clotting assessment used at the bedside to analyze the entire process of clotting, including both platelet and coagulation function ( 40 ). TEG may determine whether pericardiocentesis would be safe in patients with platelet counts below 30,000 ( 36 ), but the current data is limited. Abnormal TEG results require correction prior to the procedure with a platelet transfusion or the necessary blood products.…”

Section: Interventional Cardio-oncologymentioning

confidence: 99%

“…Thrombocytopenia is traditionally considered a relative contraindication to pericardiocentesis for patients with pericardial effusions ( 41 ). However, a recent study showed that pericardiocentesis was safe and effective in the setting of malignancy and thrombocytopenia ( 36, 42 ). Pericardiocentesis on thrombocytopenic patients may be performed under echocardiographic and/or fluoroscopic guidance.…”

Section: Interventional Cardio-oncologymentioning

confidence: 99%

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Interventional Cardio-Oncology: Adding a New Dimension to the Cardio-Oncology Field

Liu

Agha

Lopez‐Mattei

et al. 2018

Front. Cardiovasc. Med.

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The management of cardiovascular disease in patients with active cancer presents a unique challenge in interventional cardiology. Cancer patients often suffer from significant comorbidities such as thrombocytopenia and coagulopathic and/or hypercoagulable states, which complicates invasive evaluation and can specifically be associated with an increased risk for vascular access complications. Furthermore, anticancer therapies cause injury to the vascular endothelium as well as the myocardium. Meanwhile, improvements in diagnosis and treatment of various cancers have contributed to an increase in overall survival rates in cancer patients. Proper management of this patient population is unclear, as cancer patients are largely excluded from randomized clinical trials on percutaneous coronary intervention (PCI) and national PCI registries. In this review, we will discuss the role of different safety measures that can be applied prior to and during these invasive cardiovascular procedures as well as the role of intravascular imaging techniques in managing these high risk patients.

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Echocardiography and Fluoroscopy-Guided Pericardiocentesis for Cancer Patients With Cardiac Tamponade and Thrombocytopenia

Cited by 16 publications

References 2 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

A contemporary look at pericardiocentesis

Interventional Cardio-Oncology: Adding a New Dimension to the Cardio-Oncology Field

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