Hemorrhagic Pericardial Effusion From Apixaban Use: Case Report and Literature Review

Area of Science:

• Cardiology
• Pharmacology

Background:

• Direct oral anticoagulants (DOACs) offer a convenient alternative to warfarin for stroke prophylaxis in non-valvular atrial fibrillation.
• DOACs are generally well-tolerated, with bleeding being the most common adverse event, typically gastrointestinal.
• Spontaneous hemorrhagic pericardial effusion is an infrequent complication associated with DOAC therapy.

Observation:

• A case report details a patient experiencing a hemorrhagic pericardial effusion three days post-initiation of apixaban.
• This adverse event occurred despite the general safety profile of apixaban.

Findings:

• The case highlights a rare but significant complication of apixaban therapy.
• Current literature on DOAC-associated hemorrhagic pericardial effusions is summarized.
• An identified risk factor potentially predisposing patients to this complication is discussed.

Implications:

• Clinicians should be aware of the potential for hemorrhagic pericardial effusion with DOACs, particularly apixaban.
• Early recognition and management are crucial for patients presenting with symptoms suggestive of pericardial effusion.
• Further research is warranted to elucidate risk factors and optimize patient selection for DOAC therapy.