Intra-pericardial thrombin injection in iatrogenic cardiac tamponade: a case report

Area of Science:

• Cardiology
• Interventional Cardiology
• Oncology

Background:

• Percutaneous procedures are increasing, leading to potential complications like cardiac tamponade.
• Cardiac tamponade, though rare, can be life-threatening due to hemodynamic instability.
• Standard pericardiocentesis may not achieve hemostasis, necessitating alternative strategies.

Purpose of the Study:

• To report a case of iatrogenic cardiac tamponade following an endomyocardial biopsy.
• To evaluate the efficacy of intra-pericardial thrombin in achieving hemostasis in a hemodynamically unstable patient with high surgical risk.

Main Methods:

• A case report of an 89-year-old patient with melanoma treated with pembrolizumab.
• Diagnosis of iatrogenic cardiac tamponade after endomyocardial biopsy, leading to hemodynamic instability.
• Management involved pericardial drainage followed by intra-pericardial thrombin administration for hemostasis.

Main Results:

• The patient developed iatrogenic cardiac tamponade and hemodynamic instability post-biopsy.
• Pericardial drainage provided temporary relief but instability persisted.
• Intra-pericardial thrombin successfully achieved hemostasis in this high-risk patient.

Conclusions:

• Iatrogenic cardiac tamponade is a serious complication of percutaneous interventions.
• Intra-pericardial thrombin may be a viable option for hemostasis in select cases of hemodynamic instability and high surgical risk.
• Further research is needed to establish the evidence base for intra-pericardial thrombin in cardiac tamponade management.