Pericardial Effusion Associated With Direct Oral Anticoagulant Use in a Single Center Experience

Area of Science:

• Cardiology
• Pharmacology
• Oncology

Background:

• Pericardial effusion (PEff) is a known complication associated with direct oral anticoagulants (DOACs).
• Existing data on the incidence and risk factors for DOAC-associated PEff require further investigation.

Purpose of the Study:

• To determine the incidence and characteristics of PEff in patients using DOACs.
• To identify predisposing factors for PEff in patients on DOACs.

Main Methods:

• Retrospective single-center study analyzing adult patients from 2013-2023.
• Multivariable logistic regression used to identify factors associated with PEff.
• Comparison of PEff incidence between DOAC users, warfarin users, and non-anticoagulated patients.

Main Results:

• Annual incidence of PEff was 0.069% for DOACs, 0.047% for warfarin, and 0.001% for no anticoagulation.
• DOAC-PEff patients were older and more likely to be on amiodarone.
• Factors associated with large PEff included DOACs, warfarin, amiodarone use, and solid tumors.

Conclusions:

• This study presents the largest single-center case series of DOAC-associated PEff, revealing a higher incidence than previously documented.
• Further research is warranted to explore pharmacokinetic interactions and cost-effectiveness of enhanced PEff surveillance in high-risk patients.
• DOACs are associated with an increased risk of pericardial effusion, particularly in older patients with concurrent amiodarone use or solid tumors.