Spontaneous Anticoagulant-Induced Hemopericardium with Tamponade

Granot, H.; Shinar, Eilat

doi:10.1159/000207006

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…Granot and Shiner,3 Kamthorn and Marwick,4 and Yu-Cheng et al 5 described spontaneous haemopericardium in a patient on warfarin. In all these cases, no evidence of infective, autoimmune or malignant causes was found and warfarin treatment was thought to be the cause.…”

Section: Discussionmentioning

confidence: 99%

Cardiac tamponade secondary to haemopericardium in a patient on warfarin

Al-Jundi¹,

Rubin²

2010

Case Reports

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Excessive anticoagulation with warfarin may contribute to certain complications, including bleeding into body cavities. Haemopericardiac tamponade secondary to warfarin is rare outside cardiac surgery. The present report describes an unusual presentation of spontaneous cardiac tamponade in a patient on warfarin and recently treated for chest infection with erythromycin. The patient was referred to the surgeons with acute abdominal pain and hypotension. Blood tests revealed an international normalised ratio (INR) of 16.9. An emergency abdominal computed tomography (CT) scan revealed pericardial effusion. Intravenous vitamin K and prothrombin complex concentrate were administered and urgent referral to a cardiologist was made for pericardiocentesis. Monitoring INR in patients on warfarin is paramount in avoiding the potential detrimental complications of excessive anticoagulation. Clinicians should be aware of drug interactions of warfarin and risk factors associated with its prolonged half-life. Internal bleeding, including haemorrhagic cardiac tamponade, should be ruled out in patients with unexplained hypotension and excessive anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Cardiac tamponade secondary to haemopericardium in a patient on warfarin

Al-Jundi¹,

Rubin²

2010

Case Reports

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“…The patient presented with shock; his PT was 53 s with a control of 11 s. He did well after pericardiocentesis 18. Granot et al 19 described a patient who had been on warfarin for deep venous thrombosis treatment. The patient presented with shoulder pain, dyspnoea and abdominal discomfort.…”

Section: Discussionmentioning

confidence: 99%

“…The patient presented with shoulder pain, dyspnoea and abdominal discomfort. His PT was 42 s with a control of 11 s. He was found to have tamponade and did well after pericardiocentesis 19. Lee et al 20 described a patient who had been on warfarin for vertebral-basilar artery insufficiency and presented with abdominal distension.…”

Section: Discussionmentioning

confidence: 99%

Bleeding heart: a case of spontaneous hemopericardium and tamponade in a hyperthyroid patient on warfarin

et al. 2016

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We describe the case of an 81-year-old female, diagnosed with hyperthyroidism-related atrial fibrillation. Given her CHA2DS2VASc score of 3, she was started on warfarin for stroke prevention. One month later, she was admitted with cardiac tamponade. This tamponade was suspected to be secondary to hemopericardium, based on the elevated international normalized ratio (INR), drop in haemoglobin and the radiodensity (55 HU) of the pericardial effusion on CT. The patient was a Jehovah's witness who therefore initially refused measures for reversing coagulopathy. Given her coagulopathy and absence of imminent haemodynamic compromise, pericardiocentesis was deferred. Unfortunately, 1 day later, the patient deteriorated rapidly. By the time pericardiocentesis was performed and factor VIIa administered, the patient had already started developing multiple organ failure. She developed cardiac arrest and died 3 days after her admission. Only 10 cases of hemopericardium attributable to warfarin have previously been reported. In this report, we review the literature and also describe how hyperthyroidism most likely predisposed our patient to bleeding complications from warfarin.

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“…10 Haemorrhage into the pericardial sac in the absence of a local pathological lesion (spontaneous haemopericardium) while on warfarin therapy is a rare event and may present insidiously. Clinical reports of spontaneous haemopericardium describe increasing chest pain and breathlessness over two weeks, 11 breathlessness, weight gain and abdominal distension over three weeks, 12 signs of an enlarging heart and unexplained fever over 10 days, 13 and cardiogenic shock 20 days after commencing warfarin. 13 A slowly increasing haemopericardium may explain at least…”

Section: Discussionmentioning

confidence: 99%

Fatal haemopericardium and gastrointestinal haemorrhage due to possible interaction of cranberry juice with warfarin

Griffiths

Beddall

Pegler

2008

Journal of the Royal Society for the Promotion of Health

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We report a case of fatal internal haemorrhage in an elderly man who consumed only cranberry juice for two weeks while maintaining his usual dosage of warfarin. We propose that naturally occurring compounds such as flavonoids, which are present in fruit juices, may increase the potency of warfarin by competing for the enzymes that normally inactivate warfarin. While traditionally regarded as foodstuffs, consumption of fruit juices should be considered when patients develop adverse drug reactions.

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Spontaneous Anticoagulant-Induced Hemopericardium with Tamponade

Cited by 8 publications

References 4 publications

Cardiac tamponade secondary to haemopericardium in a patient on warfarin

Cardiac tamponade secondary to haemopericardium in a patient on warfarin

Bleeding heart: a case of spontaneous hemopericardium and tamponade in a hyperthyroid patient on warfarin

Fatal haemopericardium and gastrointestinal haemorrhage due to possible interaction of cranberry juice with warfarin

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