vitamin-k-1 and Pericardial-Effusion

Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Atrial Fibrillation; Blood Coagulation; Cardiac Tamponade; Catheter Ablation; China; Female; Hemorrhage; Heparin; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Perioperative Period; Protamines; Retrospective Studies; Stroke; Vitamin K 1; Warfarin

Hemorrhage resulting from ingestion of anticoagulant rodenticides may be evident at any traumatized site or in any body cavity. It is important for clinicians to include coagulopathies among the differential diagnoses for pericardial effusion and to evaluate clotting function before routine pericardiocentesis is performed.

Topics: 4-Hydroxycoumarins; Animals; Anti-Arrhythmia Agents; Blood Coagulation Disorders; Blood Transfusion; Cardiac Tamponade; Diagnosis, Differential; Dog Diseases; Dogs; Electrocardiography; Female; Lidocaine; Partial Thromboplastin Time; Pericardial Effusion; Quinidine; Radiography, Thoracic; Rodenticides; Vitamin K 1

Topics: Adult; Blood Transfusion; Humans; Male; Myocardial Infarction; Pericardial Effusion; Pericarditis; Vitamin K 1; Warfarin