Spontaneous Hemorrhagic Pericardial Effusion as a Consequence of Apixaban Utilization for New-Onset Atrial Fibrillation

Abstract

Although anticoagulation stands as a standardized therapeutic approach for mitigating thrombotic risks in atrial fibrillation, the potential for bleeding associated with direct oral anticoagulants (DOACs) is consistently weighed in the risk/benefit analysis prior to initiating therapy for non-valvular atrial fibrillation. While the typical bleeding risks from DOACs predominantly affect the gastrointestinal system, occurrences of spontaneous hemorrhagic pericardial effusions are rare. This case presentation illustrates a patient developing spontaneous hemorrhagic pericardial effusion four days after commencing apixaban therapy and subsequent management.

Keywords: apixaban; cardiology; eliqius; pericardial effusion; pericardiocentesis.

Figure 1. Chest X-ray (PA view)

PA: Posterianterior

Figure 2. Initial electrocardiogram

Figure 3. Transthoracic echocardiogram

The echocardiogram in the Parasternal Long Axis View (PLAX) is showing a large pericardial effusion.

Figure 4. Interval transthoracic echocardiogram (PLAX)

PLAX: Parasternal Long Axis View The white circle shows the resolved pericardial effusion.

Figure 5. Post-pericardiocentesis EKG (atrial fibrillation without low voltage QRS)