Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Nov;20(11S):15-20.
doi: 10.1016/j.carrev.2019.04.002. Epub 2019 Apr 4.

Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and Systematic Review of Literature

Zain Ul Abideen Asad  1 , Sardar Hassan Ijaz  2 , Amna Mohyud Din Chaudhary  3 , Safi U Khan  4 , Aneesh Pakala  2
Affiliations
Case Reports

Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and Systematic Review of Literature

Zain Ul Abideen Asad et al. Cardiovasc Revasc Med. 2019 Nov.

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.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Preferred reporting items for systematic reviews and meta-analysis flow diagram.
See this image and copyright information in PMC

References

    1. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365(11):981–92. - PubMed
    1. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013;369(9):799–808. - PubMed
    1. Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American society of clinical oncology clinical practice guideline update 2014. J Clin Oncol 2015;33(6):654–6. - PMC - PubMed
    1. Spodick DH. Acute cardiac tamponade. N Engl J Med 2003;349(7):684–90. - PubMed
    1. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009;151(4):W65–94. - PubMed

MeSH terms

LinkOut - more resources