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Apixaban-Induced Spontaneous Hemorrhagic Cardiac Tamponade
Jeewan Ambat1, Siddharth Patel2, Prutha R Pathak3
1Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA.
Cureus
|April 4, 2024
Summary
Direct oral anticoagulants (DOACs) like apixaban can rarely cause spontaneous hemorrhagic cardiac tamponade, especially in patients with chronic kidney disease. Prompt recognition and treatment are crucial for patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Direct oral anticoagulants (DOACs) are widely used for thromboembolic disease prevention.
- Apixaban, a common DOAC, requires careful consideration in patients with impaired renal or hepatic function.
- Chronic kidney disease (CKD) itself is a risk factor for bleeding complications.
Observation:
- A 72-year-old woman with CKD developed shortness of breath and chest pain.
- She was initiated on hemodialysis and later started on apixaban for atrial fibrillation.
- Within 72 hours of apixaban initiation, she developed cardiac tamponade due to a large pericardial effusion.
Findings:
- The patient was diagnosed with spontaneous hemorrhagic cardiac tamponade attributed to apixaban.
- Potential contributing factors included impaired drug metabolism in CKD and amiodarone's inhibition of apixaban transport.
- Discontinuation of anticoagulation led to patient recovery.
Implications:
- This case highlights a rare but serious adverse event associated with apixaban use.
- Clinicians should be vigilant for cardiac tamponade in patients on DOACs, particularly those with CKD.
- Understanding drug metabolism and interactions is vital for safe anticoagulation management.
