Hemopericardium in a Patient Treated with Dabigatran Etexilate

Barton, Cassie A.; McMillian, Wesley D.; Raza, Sadi; Keller, Ray

doi:10.1002/j.1875-9114.2012.01036.x

Cited by 43 publications

(37 citation statements)

References 14 publications

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“…In addition, an increasing number of patients are treated nowadays by novel oral anticoagulants (NOACs), for which assays to monitor the coagulation status are not yet commonly available. This may expose patients to lifethreatening bleeding, including pericardial effusion, which was recently reported in patients receiving NOACs [19,20].…”

Section: Discussionmentioning

confidence: 98%

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

et al. 2016

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Results: Cardiac tamponade was observed in 83 patients (52% females). Major etiologies included complications of percutaneous cardiac interventions (36%) and malignancies (primarily lung cancer; 23%), infectious/inflammatory causes (15%) and mechanical complications of myocardial infarction (12%). Sixteen (19%) patients died during the index hospitalization. Acute presentation of symptoms and lower quantity of effusion were associated with in-hospital mortality (p = 0.045 and p = 0.007). Tamponade secondary to malignancy was associated with the most substantial increment in post-discharge mortality (from 16% in-hospital to 68% 1-year mortality). During the mean follow-up of 45 months, 39 (45%) patients died. Malignancies, mechanical complications of myocardial infarction and bleeding/coagulation abnormalities were etiologies associated with poor survival (80% mortality during follow-up). Tamponade secondary to complications of percutaneous cardiac interventions or infectious/inflammatory causes were associated with significantly lower mortality (28% and 17%; log rank p < 0.001 (Cardiol J 2016; 23, 1: 57-63)

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Section: Discussionmentioning

confidence: 98%

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

et al. 2016

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“…Since dabigatran's approval for clinical use by the Food and Drug Administration (FDA) and European Medicines Agency (EMEA), numerous reports have appeared of bleeding complications [7][8][9][10][11][12][13][14][15][16][17]. In the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) study, the rate of overall major bleeding was similar between dabigatran and warfarin.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Elimination of Dabigatran Through Extracorporeal Methods

2014

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Several pharmacokinetic studies have suggested that dabigatran possesses a number of ideal properties for expedited removal via extracorporeal methods. However, this practice has not been prospectively evaluated in patients with life-threatening bleeding or requiring emergency surgery secondary to dabigatran-associated coagulopathy. The purpose of this literature review is to evaluate the published evidence surrounding extracorporeal removal of dabigatran in the setting of emergency surgery or life-threatening bleeding. A query of MEDLINE, Web of Science, International Pharmaceutical Abstracts, and Google Scholar using the terms dabigatran, dabigatran etexilate, hemodialysis, renal replacement therapy, hemorrhage, and atrial fibrillation was used to retrieve relevant literature. Furthermore, a manual search of the references of the identified literature was performed to capture additional data. Current evidence suggests that extracorporeal removal of dabigatran may play a role in the setting of life-threatening bleeding and emergent surgery. Conflicting evidence exists with regard to the potential for redistribution based on serum dabigatran concentrations. In addition, a number of practicalities must be considered before incorporating this technique in the clinical setting. Extracorporeal removal of dabigatran may be a treatment modality in selected patients who require emergency reversal.

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“…[7][8][9] Our report highlights a rare case of dabigatran-induced hemopericardium and tamponade in a patient who had no clinical evidence of pericarditis, trauma, or renal failure. 10 Spontaneous hemopericardium without tamponade has occurred in patients who took dabigatran, 2 rivaroxaban, 11 and apixaban. 12 Warfarin-associated spontaneous hemopericardium is very rare, and reported cases have been in the context of coagulopathy, [13][14][15][16] cardiac surgery, 17 or pericarditis.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 Several cases of dabigatran-induced hemopericardium have been reported. 2,10,20,21 Dy and Shiltz 10 reported 2 such cases, with cardiac tamponade in the presence of acute renal failure. Both patients had a CrCl of <30 mL/ min.…”

Section: Discussionmentioning

confidence: 99%

Dabigatran-Induced Spontaneous Hemopericardium and Cardiac Tamponade

Jelani¹,

Gordon²,

Schussheim³

2017

Texas Heart Institute Journal

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1 Hemopericardium has rarely been described in association with the use of oral anticoagulants, including the novel oral anticoagulant agents. We report a case of spontaneous hemopericardium during dabigatran therapy and its reversal with use of the antibody fragment idarucizumab. To our knowledge, this is only the second report of dabigatran-induced spontaneous hemopericardium in the absence of predisposing factors. Case ReportIn April 2016, an 87-year-old man with well-controlled hypertension and dyslipidemia was admitted to the hospital with worsening dyspnea on exertion. Two months earlier, he had been prescribed dabigatran (150 mg, twice daily) and metoprolol as therapy for AF of unknown duration. A transthoracic echocardiogram (TTE) at that time had shown nothing notable. He subsequently developed progressive edema, renal insufficiency, hypotension, and tachycardia. His medications included dabigatran, furosemide, metolazone, and metoprolol.His vital signs upon admission were as follows: blood pressure, 90/50 mmHg; heart rate, 112 beats/min; respiratory rate, 18 breaths/min; and oxygen saturation, 95% on room air. His body weight was 81.6 kg (body mass index, 25.83 kg/m 2 ). He had jugular venous distention with a positive Kussmaul sign and bilateral, pitting lowerextremity edema. No other cardiac or respiratory findings were noteworthy.Laboratory test results included new anemia (hemoglobin, 9.7 g/dL) and acute kidney injury (increase in creatinine, from 1.0 to 1.9 mg/dL). The estimated creatinine clearance (CrCl) was 33 mL/min. Results of coagulation studies were normal. An electrocardiogram revealed AF with a ventricular rate of 110 beats/min and new low voltage in all leads (Fig. 1). A TTE showed a large pericardial effusion with tamponade physiology and diastolic compression of the right ventricle ( Fig. 2A), a severely dilated inferior vena cava without inspiratory collapse (Fig. 2B), and respiratory variation at the tricuspid inflow with >25% increase during inspiration (Fig. 2C). Idarucizumab was administered, after which emergency pericardiocentesis yielded 750 cc of hemorrhagic pericardial fluid. Fluid samples evaluated by gram stain, culture, and cytology were negative. The patient reported immediate resolution of his symptoms. Serial TTEs revealed no reaccumulation of fluid (Fig. 3). The patient was discharged from the hospital in stable condition, without the need for anticoagulation. Case ReportsQurat-ul-ain Jelani, MD Ram Gordon, MD Adam Schussheim, MD

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Hemopericardium in a Patient Treated with Dabigatran Etexilate

Cited by 43 publications

References 14 publications

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

Enhanced Elimination of Dabigatran Through Extracorporeal Methods

Dabigatran-Induced Spontaneous Hemopericardium and Cardiac Tamponade

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