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Failed pericardiocentesis for acute cardiac tamponade: two cases associated with bivalirudin administration during

Owayed M Al Shammeri1, Richard Crowell, Keir Stewart

  • 1Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 24, 2009
PubMed

Insights

Successful management of acute cardiac tamponade requires sealing coronary artery perforation and pericardiocentesis. However, bivalirudin use during PCI can lead to pericardial thrombus, complicating pericardiocentesis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Acute cardiac tamponade is a life-threatening complication during percutaneous coronary intervention (PCI).
  • Standard management involves sealing the coronary artery perforation and performing pericardiocentesis.
  • Bivalirudin is an anticoagulant often used during PCI, particularly in patients with or at high risk of heparin-induced thrombocytopenia.

Observation:

  • Two cases of acute cardiac tamponade during PCI are presented.
  • These cases occurred in patients who received bivalirudin for anticoagulation.
  • Pericardiocentesis attempts were unsuccessful due to the presence of thrombus, not solely blood, within the pericardial space.

Findings:

  • Bivalirudin administration during PCI may lead to pericardial thrombus formation.
  • Pericardial thrombus can impede successful pericardiocentesis in cases of cardiac tamponade.
  • This finding highlights a potential challenge in managing PCI-related cardiac tamponade when bivalirudin is used.

Implications:

  • Clinicians should consider the potential for pericardial thrombus when managing cardiac tamponade post-PCI with bivalirudin.
  • Alternative or adjunctive procedures may be necessary if pericardiocentesis is unsuccessful due to thrombus.
  • Further research is warranted to elucidate the mechanism and optimal management strategies for bivalirudin-associated pericardial thrombus during PCI.

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