Related Experiment Video
Updated: Jul 25, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Cardiac Tamponade in Patients Treated with Direct Oral Anticoagulants
Mustafa Gabarin1, Yoav Arnson2, Yoram Neuman2
1Department of Cardiology, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Hemorrhagic cardiac tamponade is a rare complication in patients taking direct oral anticoagulants (DOACs). This study found a good short-term prognosis for patients undergoing pericardiocentesis for this condition.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Direct oral anticoagulants (DOACs) are standard for non-valvular atrial fibrillation.
- Bleeding risk remains a significant concern with DOAC therapy.
- Hemorrhagic cardiac tamponade is a rare but serious complication.
Purpose of the Study:
- To evaluate the characteristics of patients on DOACs who develop cardiac tamponade.
- To assess the clinical outcomes of these patients.
Main Methods:
- Retrospective identification of 11 patients with DOAC-associated pericardial tamponade (2018-2021).
- Analysis of patient demographics, DOAC type, and management strategies.
- Review of procedural outcomes and discharge diagnoses.
Main Results:
- All 11 patients had atrial fibrillation as the indication for anticoagulation.
- Apixaban was the most common DOAC (8 patients).
- Pericardiocentesis was successful in 10 patients; one required surgical drainage. No in-hospital deaths occurred.
Conclusions:
- Hemorrhagic cardiac tamponade is an infrequent complication of DOAC use.
- Pericardiocentesis offers a good short-term prognosis for managing this condition.
Background:
Direct oral anticoagulants (DOACs) are the treatment of choice for patients with non-valvular atrial fibrillation; however, bleeding risk remains significant. We reported a single-center experience with 11 patients who presented with hemorrhagic cardiac tamponade while treated with DOACs.
Objectives:
To evaluate the characteristics and clinical outcomes of patients under DOACs with cardiac tamponade.
Methods:
We retrospectively identified 11 patients treated with DOACs admitted with pericardial tamponade in our cardiology unit during 2018-2021.
Results:
The mean age was 84 ± 4 years; 7 males. Atrial fibrillation was the indication for anticoagulation in all cases. DOACs included apixaban (8 patients), dabigatran (2 patients), and rivaroxaban (1 patient). Urgent pericardiocentesis via a subxiphoid approach under echocardiography guidance was successfully performed in 10 patients. One patient was treated with urgent surgical drainage with a pericardial window. Reversal of anticoagulation using prothrombin complex concentrate and idarucizumab was given before the procedure to 6 patients treated with apixaban and one patient treated with dabigatran. One patient, initially treated with urgent pericardiocentesis, underwent pericardial window surgery due to re-accumulation of blood in the pericardium. The pericardial fluid analysis demonstrated hemopericardium. Cytology tests were negative for malignant cells in all cases. Discharge diagnoses regarding the cause of hemopericardium included pericarditis (3 patients) and idiopathic (8 patients). Medical therapy included non-steroidal anti-inflammatory drugs (1 patient), colchicine (3 patients), and steroids (3 patients). No patient died during hospitalization.
Conclusions:
Hemorrhagic cardiac tamponade is a rare complication of DOACs. We found good short-term prognosis following pericardiocentesis.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:25Pericarditis IV: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management