warfarin and Pericardial-Effusion

Topics: Adult; Anticoagulants; Cardiac Tamponade; Diagnosis, Differential; Echocardiography; Hemorrhage; Humans; Male; Multiple Trauma; Pericardial Effusion; Radiography, Thoracic; Warfarin

We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin.. This study was a prospective, randomized registry. Patients taking NOACs upon visiting our hospital were randomly assigned into 2 groups; rivaroxaban and apixaban. Warfarin was continued in patients taking warfarin. Asymptomatic cerebral microthromboembolism was evaluated by magnetic resonance imaging on the day after the ablation procedure. In 176 consecutive patients (101 paroxysmal, and 75 persistent AF), rivaroxaban was used in 55, apixaban in 51, and warfarin in 70. There were no symptomatic cerebral infarctions in this study. Asymptomatic cerebral microthromboembolism was detected in 32 (18.4%) patients; nine (16.4%) with rivaroxaban, 10 (20%, p=0.80; vs. rivaroxaban) with apixaban, and 13 (18.8%, p=0.81; vs. rivaroxaban) with warfarin. Hemopericardium occurred in 5 (2.8%) patients; 2 with rivaroxaban, 1 with apixaban (p=1.0; vs. rivaroxaban), and 2 with warfarin (p=1.0; vs. rivaroxaban). In multivariate analysis, concomitant coronary angiography (p<0.05, odds ratio 5.73) was a predictor of cerebral thromboembolism.. The incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation is similar among the periprocedural use of rivaroxaban, apixaban, and warfarin.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Catheter Ablation; Combined Modality Therapy; Coronary Angiography; Factor Xa Inhibitors; Female; Humans; Incidence; Intracranial Thrombosis; Magnetic Resonance Angiography; Male; Middle Aged; Pericardial Effusion; Prospective Studies; Pyrazoles; Pyridones; Registries; Rivaroxaban; Warfarin

The Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) randomized trial compared left atrial appendage closure against warfarin in atrial fibrillation (AF) patients with CHADS₂ ≥1. Although the study met the primary efficacy end point of being noninferior to warfarin therapy for the prevention of stroke/systemic embolism/cardiovascular death, there was a significantly higher risk of complications, predominantly pericardial effusion and procedural stroke related to air embolism. Here, we report the influence of experience on the safety of percutaneous left atrial appendage closure.. The study cohort for this analysis included patients in the PROTECT AF trial who underwent attempted device left atrial appendage closure (n=542 patients) and those from a subsequent nonrandomized registry of patients undergoing Watchman implantation (Continued Access Protocol [CAP] Registry; n=460 patients). The safety end point included bleeding- and procedure-related events (pericardial effusion, stroke, device embolization). There was a significant decline in the rate of procedure- or device-related safety events within 7 days of the procedure across the 2 studies, with 7.7% and 3.7% of patients, respectively, experiencing events (P=0.007), and between the first and second halves of PROTECT AF and CAP, with 10.0%, 5.5%, and 3.7% of patients, respectively, experiencing events (P=0.006). The rate of serious pericardial effusion within 7 days of implantation, which had made up >50% of the safety events in PROTECT AF, was lower in the CAP Registry (5.0% versus 2.2%, respectively; P=0.019). There was a similar experience-related improvement in procedure-related stroke (0.9% versus 0%, respectively; P=0.039). Finally, the functional impact of these safety events, as defined by significant disability or death, was statistically superior in the Watchman group compared with the warfarin group in PROTECT AF. This remained true whether significance was defined as a change in the modified Rankin score of ≥1, ≥2, or ≥3 (1.8 versus 4.3 events per 100 patient-years; relative risk, 0.43; 95% confidence interval, 0.24 to 0.82; 1.5 versus 3.7 events per 100 patient-years; relative risk, 0.41; 95% confidence interval, 0.22 to 0.82; and 1.4 versus 3.3 events per 100 patient-years; relative risk, 0.43; 95% confidence interval, 0.22 to 0.88, respectively).. As with all interventional procedures, there is a significant improvement in the safety of Watchman left atrial appendage closure with increased operator experience. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00129545.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Appendage; Cardiac Catheterization; Echocardiography, Transesophageal; Embolism; Female; Humans; Male; Middle Aged; Pericardial Effusion; Randomized Controlled Trials as Topic; Stroke; Treatment Outcome; Warfarin

In patients with non-valvular atrial fibrillation, embolic stroke is thought to be associated with left atrial appendage (LAA) thrombi. We assessed the efficacy and safety of percutaneous closure of the LAA for prevention of stroke compared with warfarin treatment in patients with atrial fibrillation.. Adult patients with non-valvular atrial fibrillation were eligible for inclusion in this multicentre, randomised non-inferiority trial if they had at least one of the following: previous stroke or transient ischaemic attack, congestive heart failure, diabetes, hypertension, or were 75 years or older. 707 eligible patients were randomly assigned in a 2:1 ratio by computer-generated randomisation sequence to percutaneous closure of the LAA and subsequent discontinuation of warfarin (intervention; n=463) or to warfarin treatment with a target international normalised ratio between 2.0 and 3.0 (control; n=244). Efficacy was assessed by a primary composite endpoint of stroke, cardiovascular death, and systemic embolism. We selected a one-sided probability criterion of non-inferiority for the intervention of at least 97.5%, by use of a two-fold non-inferiority margin. Serious adverse events that constituted the primary endpoint for safety included major bleeding, pericardial effusion, and device embolisation. Analysis was by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00129545.. At 1065 patient-years of follow-up, the primary efficacy event rate was 3.0 per 100 patient-years (95% credible interval [CrI] 1.9-4.5) in the intervention group and 4.9 per 100 patient-years (2.8-7.1) in the control group (rate ratio [RR] 0.62, 95% CrI 0.35-1.25). The probability of non-inferiority of the intervention was more than 99.9%. Primary safety events were more frequent in the intervention group than in the control group (7.4 per 100 patient-years, 95% CrI 5.5-9.7, vs 4.4 per 100 patient-years, 95% CrI 2.5-6.7; RR 1.69, 1.01-3.19).. The efficacy of percutaneous closure of the LAA with this device was non-inferior to that of warfarin therapy. Although there was a higher rate of adverse safety events in the intervention group than in the control group, events in the intervention group were mainly a result of periprocedural complications. Closure of the LAA might provide an alternative strategy to chronic warfarin therapy for stroke prophylaxis in patients with non-valvular atrial fibrillation.. Atritech.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Appendage; Atrial Fibrillation; Cardiac Catheterization; Embolism; Europe; Female; Follow-Up Studies; Hemorrhage; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pericardial Effusion; Proportional Hazards Models; Prostheses and Implants; Prosthesis Design; Risk Factors; Safety; Stroke; Treatment Outcome; United States; Warfarin

We present the case of an adult man with cardiofaciocutaneous syndrome, who initially presented to the emergency department with severe abdominal pain and distension, but was diagnosed with cardiac tamponade on CT after distended neck veins and tachycardia were identified on examination. He had emergency pericardial drainage to relieve the haemopericardium and was treated with colchicine. He was further found to be deficient in factors II, VII and X despite not being on warfarin, and was therefore supplemented with vitamin K. This confirms a diagnosis of vitamin K deficiency, likely multifactorial from malabsorption due to chronic intestinal pseudo-obstruction, small bowel obstruction and possibly exacerbated by subsequent ciprofloxacin use for small intestine bacterial overgrowth. This is the first report of spontaneous haemopericardium secondary to vitamin K deficiency in an adult patient not on anticoagulation, and is an important learning point due to the life-threatening progression of the haemopericardium and cardiac tamponade.

Topics: Adult; Cardiac Tamponade; Humans; Male; Pericardial Effusion; Vitamin K Deficiency; Warfarin

Novel oral anticoagulants (NOAC) have been shown to have comparable risk profiles compared with warfarin. However, data on the use of NOACs in cardiac surgery patients is limited. The aim of this study is to compare postoperative effusion rates in patients who were anticoagulated with NOACs vs warfarin after coronary artery bypass grafting (CABG).. A retrospective review of 2017 patients undergoing isolated CABG from 2014 to 2017 was performed. Of those patients, 246 patients (12.2%) were placed on either a NOAC or warfarin postoperatively. The combined rates of postoperative pericardial and pleural effusions requiring invasive intervention during the index hospitalization and up to 3 months postoperatively were compared between patients who were placed on NOACs vs warfarin.. Of the 246 patients placed on oral anticoagulation after isolated CABG, 64 (26.0%) were placed on NOACs, and 182 (74.0%) received warfarin. There were no significant differences in preoperative coagulation profile and use of anticoagulation and antiplatelets preoperatively between the groups. Of the patients anticoagulated with NOACs postoperatively, 17 patients (26.6%) required invasive interventions for effusions compared with 24 patients (13.2%) in the cohort anticoagulated with warfarin (P < 0.014). Of the patients who required interventions for effusions, those on NOACs were more likely to require delayed interventions compared with those on warfarin.. Patients receiving NOACs after CABG are at increased risk of developing effusions requiring invasive interventions compared to patients receiving warfarin. This increased risk should be taken into consideration when choosing the appropriate anticoagulation strategy for postoperative patients with CABG.

Topics: Administration, Oral; Aged; Anticoagulants; Antithrombins; Coronary Artery Bypass; Factor Xa Inhibitors; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pleural Effusion; Postoperative Care; Postoperative Complications; Retrospective Studies; Risk; Warfarin

We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

Topics: Administration, Oral; Anticoagulants; Bioprosthesis; Blood Coagulation; Device Removal; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hematuria; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Pericardial Effusion; Postoperative Hemorrhage; Prosthesis Design; Reoperation; Risk Factors; Thrombasthenia; Treatment Outcome; Warfarin; Young Adult

We describe the case of an 81-year-old female, diagnosed with hyperthyroidism-related atrial fibrillation. Given her CHA2DS2VASc score of 3, she was started on warfarin for stroke prevention. One month later, she was admitted with cardiac tamponade. This tamponade was suspected to be secondary to hemopericardium, based on the elevated international normalized ratio (INR), drop in haemoglobin and the radiodensity (55 HU) of the pericardial effusion on CT. The patient was a Jehovah's witness who therefore initially refused measures for reversing coagulopathy. Given her coagulopathy and absence of imminent haemodynamic compromise, pericardiocentesis was deferred. Unfortunately, 1 day later, the patient deteriorated rapidly. By the time pericardiocentesis was performed and factor VIIa administered, the patient had already started developing multiple organ failure. She developed cardiac arrest and died 3 days after her admission. Only 10 cases of hemopericardium attributable to warfarin have previously been reported. In this report, we review the literature and also describe how hyperthyroidism most likely predisposed our patient to bleeding complications from warfarin.

Topics: Aged, 80 and over; Anticoagulants; Cardiac Tamponade; Fatal Outcome; Female; Humans; Hyperthyroidism; Pericardial Effusion; Warfarin

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

Topics: Anticoagulants; Cardiac Tamponade; Gastrostomy; Humans; Male; Medication Errors; Middle Aged; Nursing Homes; Pericardial Effusion; Physician-Nurse Relations; Text Messaging; Warfarin

A 66-year-old man was implanted with a pacemaker. Seven years after implantation he was admitted due to cardiogenic cerebral embolism and warfarin therapy was introduced. After that, he suffered recurrent pericardial effusion for unexplained reasons. An exploratory thoracotomy revealed that the screw of the atrial lead had penetrated through the right auricular appendage wall.

Topics: Aged; Anticoagulants; Atrial Appendage; Electrodes, Implanted; Humans; Male; Pacemaker, Artificial; Pericardial Effusion; Recurrence; Treatment Outcome; Warfarin; Wounds, Penetrating

A 53-year-old man on warfarin for postoperative pulmonary embolism presented with chest pain and was found to be in cardiac tamponade due to an atraumatic haemopericardium. Findings of tamponade and a novel approach to the pathophysiology of pericardial disease to explain these finding are presented.

Topics: Anticoagulants; Cardiac Tamponade; Diagnosis, Differential; Electrocardiography; Humans; Male; Middle Aged; Pericardial Effusion; Pulmonary Embolism; Tomography, X-Ray Computed; Warfarin

Pulmonary arterial hypertension (PAH) is a major cause of mortality in connective tissue disease (CTD). We sought to quantify survival and determine factors predictive of mortality in a cohort of patients with CTD-associated PAH (CTD-PAH) in the current era of advanced PAH therapy.. Patients with right heart catheter proven CTD-PAH were recruited from six specialised PAH treatment centres across Australia and followed prospectively. Using survival methods including Cox proportional hazards regression, we modelled for all-cause mortality. Independent variables included demographic, clinical and hemodynamic data.. Among 117 patients (104 (94.9%) with systemic sclerosis), during 2.6 ± 1.8 (mean ± SD) years of follow-up from PAH diagnosis, there were 32 (27.4%) deaths. One-, two- and three-year survivals were 94%, 89% and 73%, respectively. In multiple regression analysis, higher mean right atrial pressure (mRAP) at diagnosis (hazard ratio (HR) = 1.13, 95% CI: 1.04 to 1.24, P = 0.007), lower baseline six-minute walk distance (HR = 0.64, 95% CI: 0.43 to 0.97, P = 0.04), higher baseline World Health Organization functional class (HR = 3.42, 95% CI: 1.25 to 9.36, P = 0.04) and presence of a pericardial effusion (HR = 3.39, 95% CI: 1.07 to 10.68, P = 0.04) were predictive of mortality. Warfarin (HR = 0.20, 95% CI: 0.05 to 0.78, P = 0.02) and combination PAH therapy (HR = 0.20, 95% CI: 0.05 to 0.83, P = 0.03) were protective.. In this cohort of CTD-PAH patients, three-year survival was 73%. Independent therapeutic predictors of survival included warfarin and combination PAH therapy. Our findings suggest that anticoagulation and combination PAH therapy may improve survival in CTD-PAH. This observation merits further evaluation in randomised controlled trials.

Topics: Aged; Australia; Blood Pressure; Cohort Studies; Connective Tissue Diseases; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary; Male; Middle Aged; Pericardial Effusion; Prognosis; Proportional Hazards Models; Survival Rate; Walking; Warfarin

Topics: Aged; Anticoagulants; Carcinoma, Non-Small-Cell Lung; Cardiac Tamponade; Female; Humans; Pericardial Effusion; Warfarin

Topics: Angioplasty, Balloon, Coronary; Anticoagulants; Atrial Appendage; Atrial Fibrillation; Humans; Pericardial Effusion; Prostheses and Implants; Warfarin

Topics: Aged; Anticoagulants; Aortic Valve; Blood Coagulation Factors; Cardiac Tamponade; Heart; Heart Valve Prosthesis Implantation; Humans; International Normalized Ratio; Male; Marfan Syndrome; Pericardial Effusion; Pericardiectomy; Pericardium; Postoperative Complications; Postoperative Hemorrhage; Thrombosis; Warfarin

We report a case of fatal internal haemorrhage in an elderly man who consumed only cranberry juice for two weeks while maintaining his usual dosage of warfarin. We propose that naturally occurring compounds such as flavonoids, which are present in fruit juices, may increase the potency of warfarin by competing for the enzymes that normally inactivate warfarin. While traditionally regarded as foodstuffs, consumption of fruit juices should be considered when patients develop adverse drug reactions.

Topics: Aged; Anticoagulants; Beverages; Fatal Outcome; Flavonoids; Food-Drug Interactions; Gastrointestinal Hemorrhage; Humans; Male; Pericardial Effusion; Phytotherapy; Vaccinium macrocarpon; Warfarin

Warfarin is the most widely used oral anticoagulant and is indicated for many clinical conditions. Levofloxacin, a fluoroquinolone, is one of the most commonly prescribed antibiotics in clinical practice and is effective against Gram-positive, Gram-negative, and atypical bacteria. While small prospective studies have not revealed any significant drug-drug interaction between warfarin and levofloxacin, several case reports have indicated that levofloxacin may significantly potentiate the anticoagulation effect of warfarin. We report 3 cases of serious bleeding complications that appear to be the result of the interaction between warfarin and levofloxacin. Physicians should be aware of this potential interaction and use caution when prescribing levofloxacin to patients taking warfarin.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Drug Interactions; Female; Hemorrhage; Humans; Levofloxacin; Male; Ofloxacin; Pericardial Effusion; Retroperitoneal Space; Warfarin

Acute cardiac tamponade requires urgent diagnosis and treatment. We report a case involving a 70-year-old man who was receiving warfarin treatment for 12 years following mitral valve replacement. The international normalised ratio (INR) was checked and echocardiography performed regularly in the clinic. The last INR was 2.1, checked 2 weeks before admission to the emergency department. The last echocardiography performed 3 months previously revealed no pericardial effusion. The patient suffered from progressive dyspnoea and orthopnoea for several days. Cardiac tamponade was diagnosed, and the INR at that time was 7.52. Urgent pericardiocentesis and pericardiotomy were undertaken and 1300 ml of pericardial blood was drained. Following surgery the patient's recovery was uneventful. An intravenous vitamin K injection and fresh frozen plasma transfusion were administered to reverse the patient's over-anticoagulated state. The final pathology revealed chronic inflammation and there was no malignancy, and no bacteria or mycobacterium were seen. Emergency physicians should remember that over-anticoagulation with warfarin may contribute to certain complications, including haemopericardium, and that strict control of target INR should be the goal for patients who require continuous warfarin treatment.

Topics: Aged; Anticoagulants; Cardiac Tamponade; Contrast Media; Diagnosis, Differential; Echocardiography; Electrocardiography; Humans; International Normalized Ratio; Male; Pericardial Effusion; Radiography, Thoracic; Tomography, X-Ray Computed; Warfarin

Topics: Angiography; Aspirin; Coronary Aneurysm; Electrocardiography; Fever; Heart Murmurs; Humans; Immunoglobulins, Intravenous; Infant; Male; Mucocutaneous Lymph Node Syndrome; Pericardial Effusion; Tachycardia, Sinus; Warfarin

Constrictive pericarditis (CP) is an unusual sequela of cardiac surgery, so the present study evaluated the clinical characteristics of patients with CP after coronary artery bypass grafting (CABG). Four hundred and sixty-three patients who underwent isolated CABG between January 1989 and March 1999 were examined retrospectively. The first choice of treatment for postoperative pericardial effusion was non-steroid anti-inflammatory agents, and an increased dose of diuretics. The second treatment choice was corticosteroids or pericardial drainage. When CP was suspected during the follow-up period (mean, 54+/-31 months), cardiac catheterization was carried out to establish the diagnosis. Of the 463 patients undergoing CABG, there were 11 (2.4%) who developed CP after surgery. The median time to the onset of symptoms after CABG was 4 weeks (range, 3-96 weeks). On univariate and multivariate analysis, normal left ventricular ejection fraction, warfarin administration, and early postoperative pericardial effusion were significantly associated with a greater potential of postoperative CP. The effusion was bloody in all cases of pericardial drainage despite warfarin therapy. Not draining the postoperative effusive pericardial effusion was a risk factor for the development of CP. Pericardial drainage for patients with significant effusion after CABG is important for the prevention of subsequent CP, especially in those patients being treated with warfarin or with normal left ventricular function.

Topics: Aged; Aged, 80 and over; Coronary Artery Bypass; Drainage; Female; Humans; Incidence; Japan; Male; Middle Aged; Pericardial Effusion; Pericarditis, Constrictive; Postoperative Complications; Retrospective Studies; Risk Factors; Stroke Volume; Time Factors; Ventricular Function, Left; Warfarin

This study aimed at elucidating the role of anticoagulation in the genesis of late pericardial effusion and tamponade after cardiac surgery. Using serial 2-D echocardiography, 141 patients undergoing surgery for coronary artery bypass (56), valvular (69) or congenital (16) [corrected] heart disease were studied postoperatively. Group 1 (74 patients) received full anticoagulation (warfarin 73; heparin 1) and group 2 (67 patients) received either antithrombotic agents (aspirin plus dipyridamole), or no treatment. Fifty percent (70/141) of patients developed effusion. There was no significant difference between the two groups in the incidence of either effusion in general (43/74; 58% vs 27/67; 40%, respectively) or small or medium sized effusion. However, a large effusion was significantly more common in group 1 than in group 2 (32% vs 4%, P < 0.005). Twelve patients (12/141; 8.5%) developed late tamponade, 7 to 33 (15 +/- 7.3 mean +/- SD) days after surgery. All had a large effusion demonstrated by echo, drained by pericardiocentesis, and none died. All 12 patients with tamponade belonged to group 1 (P < 0.001). Excess anticoagulation was detected at least once in 41 of the 74 group 1 patients (55%). When compared to properly anticoagulated patients, excessively anticoagulated patients had a similar overall incidence of effusion and a similar incidence of small or moderate effusion, but a higher incidence of large effusion (18% vs 44%, [corrected] P < 0.05) and tamponade (3% vs 27%, P < 0.025). We conclude that, unlike small or medium-sized effusions, large pericardial effusions and tamponade are more likely to occur among anticoagulated patients, especially if they are excessively anticoagulated.

Topics: Adult; Anticoagulants; Aspirin; Cardiac Surgical Procedures; Cardiac Tamponade; Coronary Artery Bypass; Dipyridamole; Echocardiography; Female; Heart Defects, Congenital; Heart Valves; Heparin; Humans; Male; Pericardial Effusion; Postoperative Complications; Warfarin

Topics: Adult; Aged; Cardiac Surgical Procedures; Drainage; Female; Humans; Male; Middle Aged; Pericardial Effusion; Postoperative Complications; Time Factors; Warfarin

Hemopericardium developed following adequate (and not excessive) anticoagulation in a patient with acute transmural anterior myocardial infarction and an early pericardial friction rub. Drainage of a bloody effusion by pericardiocentesis did not prevent progression to constrictive pericarditis within one year. The clinical features of this case and of the only two other similar occurrences reported in the medical literature are described and lead to a discussion of therapeutic and preventive measures.

Topics: Anticoagulants; Heparin; Humans; Male; Middle Aged; Myocardial Infarction; Pericardial Effusion; Pericarditis, Constrictive; Time Factors; Warfarin

Two patients, who suffered from pericardial tamponade in the course of prophylactic anticoagulant treatment, are reported. The mitral valve had been replaced by a prosthesis in both cases. The diagnosis was suspected clinically and radiologically and proven by pericardiocentesis. One of the patients was treated by a percutaneously inserted small polyethylene tube for continous drainage and the other by thoracotomy and partial pericardiectomy. Both patients recovered and are at present asymptomatic. Th mechanism of bleeding patients receiving anticoagulant therapy is briefly discussed.

Topics: Adult; Female; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Pericardial Effusion; Postoperative Complications; Radiography; Time Factors; Warfarin

A case of organizing hemopericardium and cardiac tamponade in a patient with a permanent endocardial pacemaker who was maintained on anticoagulation is presented. The hemopericardium is concluded as solely due to the anticoagulation. A new auscultatory finding attributable to an endocardial pacemaker and a helpful radiographic sign of pericardial effusion in patients with these pacemakers is described.

Topics: Cardiac Tamponade; Heart Auscultation; Humans; Male; Middle Aged; Pacemaker, Artificial; Pericardial Effusion; Radiography; Warfarin

Topics: Heparin; Humans; Myocardial Infarction; Pericardial Effusion; Pericarditis; Shock, Cardiogenic; Warfarin

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