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Massive Tension Hemothorax After Pacemaker Implantation.

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Summary
This summary is machine-generated.

An 85-year-old male on apixaban and clopidogrel developed hemothorax after pacemaker implantation. Spontaneous intercostal vessel rupture from coughing was the likely cause.

Keywords:
cardiac pacemakercardiology devicescritical hemorrhagic shockintercostal vessel rupturetension hemothorax

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Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Interventional Cardiology

Background:

  • Pacemaker implantation is a common procedure.
  • Patients on dual antiplatelet therapy (apixaban and clopidogrel) have increased bleeding risks.
  • Complications such as hemothorax are rare but serious.

Observation:

  • An 85-year-old male on apixaban and clopidogrel underwent pacemaker implantation.
  • Post-procedure, he developed a unilateral tension hemothorax.
  • Emergent drainage and exploratory thoracotomy were required.

Findings:

  • No clear vascular, cardiac, or pulmonary source of bleeding was identified during surgery.
  • Multidisciplinary discussion suggested spontaneous intercostal vessel rupture as the most probable cause.
  • Forceful coughing and elevated blood pressure during the procedure were implicated factors.

Implications:

  • This case highlights a rare but critical complication following pacemaker implantation in patients on dual antiplatelet therapy.
  • It underscores the importance of considering less common bleeding sources in the thoracic cavity.
  • Further research into risk stratification and management strategies for such patients may be warranted.