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An Uncommon Case of Spontaneous Hemopericardium in a Patient Treated with Rivaroxaban.

ABSTRACT: We describe a case of an 88-year-old woman with a severe bluntly ematic pericardial effusion. Radiological and laboratory examinations excluded all the most common causes of hemopericardium, and the diagnosis of spontaneous hemopericardium associated with the treatment with rivaroxaban was made. This is the first case report describing a hemopericardium in a patient treated with rivaroxaban who did not take other herbal products or drugs that may significantly increase rivaroxaban blood levels. This report emphasizes the need for the careful use of new oral anticoagulants, and the importance of taking in mind uncommon side effects. Spontaneous hemopericardium should be considered in these patients.

SUBMITTER: Ioppolo AM

PROVIDER: S-EPMC7011493 | biostudies-literature | 2019 Oct-Dec

REPOSITORIES: biostudies-literature

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An Uncommon Case of Spontaneous Hemopericardium in a Patient Treated with Rivaroxaban.

Ioppolo Anna Maria AM Longobardo Luca L D'Isa Salvatore S De Gregorio Paola P Manfredi Mariella M De Cesare Nicoletta Bianca NB

Journal of cardiovascular echography 20191001 4

We describe a case of an 88-year-old woman with a severe bluntly ematic pericardial effusion. Radiological and laboratory examinations excluded all the most common causes of hemopericardium, and the diagnosis of spontaneous hemopericardium associated with the treatment with rivaroxaban was made. This is the first case report describing a hemopericardium in a patient treated with rivaroxaban who did not take other herbal products or drugs that may significantly increase rivaroxaban blood levels. ...[more]

PMID: 32090001

Similar Datasets

Hemopericardium with subsequent cardiac tamponade secondary to rivaroxaban treatment: a case report.

Project description:BackgroundThe use and utility of novel oral anticoagulants has been increasing in clinical practice due to their relatively lower incidence of side effects such as intracranial haemorrhage, particularly in the elderly, when compared with vitamin K antagonists. Rivaroxaban is a factor Xa and prothrombinase inhibitor indicated for stroke and venous thromboembolism prophylaxis in non-valvular atrial fibrillation as well as treatment of venous thromboembolism.Case summaryA patient with history of paroxysmal atrial fibrillation on Rivaroxaban presented with generalized malaise, lightheadedness, and dizziness. The patient was found to be in profound cardiogenic shock despite unremarkable cardiac enzymes. Electrocardiogram revealed rate controlled atrial fibrillation and T-wave inversions in the inferolateral leads without associated electrical alternans. Bedside echocardiogram revealed a large pericardial effusion consistent with cardiac tamponade physiology. Following anticoagulation reversal, the patient underwent urgent pericardiocentesis yielding haemorrhagic fluid, with subsequent improvement in haemodynamic status. Despite the presence of retroperitoneal lymphadenopathy on previous computed tomography of the abdomen and concern for underlying malignant effusion secondary to lymphoma, cytology of the fluid revealed no evidence of malignant cells and follow-up flow cytometry and bone marrow biopsy were unremarkable.DiscussionWhile hemopericardium is not listed as a known side effect of Rivaroxaban, previous cases of hemopericardium secondary to Rivaroxaban have been described in the literature secondary to pre-disposing risk factors including CYP450 drug interactions or cardiac device implantations. In this case, the patient experienced a spontaneous hemopericardium on Rivaroxaban without any previously elucidated risk factors or evidence of malignancy.

| S-EPMC7898561 | biostudies-literature

A Complicated Case of Transient Constrictive Pericarditis Secondary to Rivaroxaban-Associated Hemopericardium.

Project description:A 72-year-old man on rivaroxaban developed effusive constrictive pericarditis secondary to hemopericardium. His condition improved with anti-inflammatory therapy supporting a diagnosis of transient constrictive pericarditis. On follow-up, residual constriction developed requiring surgical pericardiectomy. Although many cases with transient constrictive pericarditis resolve with medical management, some may progress and require pericardiectomy. (Level of Difficulty: Advanced.).

| S-EPMC8299136 | biostudies-literature

Case Report: An Unusual Cause for Recurrent Hemopericardium in a Patient With Dyspnea.

Project description:The case concerns a female presenting with dyspnoea resulting from recurrent hemopericardium. Pericardiocentesis, coronary angiography, and extensive laboratory and imaging studies did not reveal the underlying etiology of the hemopericardium. Only after repeat and exploratory surgery, diffuse venous pericardial hemorrhages with localized thrombi typical of angiosarcoma were discovered.

| S-EPMC8634327 | biostudies-literature

A Rare Case of Spontaneous Cardiac Tamponade Induced by Concomitant Use of Rivaroxaban and Amiodarone.

Project description:Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone for pulseless ventricular tachycardia who presented to our hospital with intermittent chest pain and was diagnosed with spontaneous hemopericardium causing cardiac tamponade. The culprit drugs were discontinued, and the patient was treated with emergent pericardiocentesis. Both rivaroxaban and amiodarone are substrates for the CYP3A4 hepatic pathway, and concomitant use can result in increased plasma rivaroxaban levels causing an increased propensity to bleeding. While most physicians are cognizant of the need for renal dosing of rivaroxaban, this article aims to increase awareness of its interactions with drugs that are also metabolized through the same hepatic CYP450 pathway.

| S-EPMC6109521 | biostudies-literature

Fibrinolysis-treated myocardial infarction in a patient with missed spontaneous coronary artery dissection associated with takotsubo syndrome: case report.

Project description:BackgroundSpontaneous coronary artery dissection (SCAD) is an under-recognized acute cardiac disease entity. It is often missed, or misdiagnosed as coronary spasm, coronary atherosclerotic lesion, or thrombotic coronary occlusion. During the last years, SCAD also has been reported to be 'misdiagnosed as takotsubo syndrome (TS)' in patients with features consistent with both conditions. Spontaneous coronary artery dissection may present as an acute coronary syndrome and sometimes as sudden cardiac death.Case summaryWe report on the case of a 67-year-old woman who presented with features of ST-elevation myocardial infarction treated with fibrinolysis. The patient showed to have obtuse-marginal SCAD, which was misdiagnosed as fibrinolysis caused lysis of a coronary thrombus. The patient had moreover all other features of TS.DiscussionThis case report teaches important information about SCAD. The association between SCAD and TS are discussed.

| S-EPMC6426041 | biostudies-literature

Spontaneous cystic biloma after laparoscopic cholecystectomy treated conservatively: A case report.

Project description:IntroductionBiloma forms due to common bile duct (CBD) injury as a laparoscopic cholecystectomy complication. Spontaneous localized biloma forming cysts in the biliary duct is rare.Presentation of caseWe report a 47-year-old male with complaint of a painful lump in the upper abdomen two months after laparoscopic cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) found a large epigastric cyst mass, without any signs of CBD injury. Patient was managed with percutaneous drainage in the outpatient clinic and kept the contents of the drainage bag for evaluation. After two months follow-up the outcome was favorable.DiscussionBiloma forming cysts is a very rare complication post laparoscopic cholecystectomy. Biloma most common occurs as free fluid in the abdominal cavity. Clinical diagnostics, intraoperative historical evaluation and support with MRCP may determine the treatment options. Decision to manage with non-operative procedures by percutaneous drainage and evaluations of the patient in the outpatient clinic had a favorable outcome.ConclusionPost laparoscopic biloma cysts are a very rare case. Management with percutaneous drainage in an outpatient clinic and ambulatory drainage is an effective and safe procedure.

| S-EPMC8188253 | biostudies-literature

Spontaneous hemorrhage of an adrenal myelolipoma treated with transarterial embolization: A case report.

Project description:Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.

| S-EPMC7214766 | biostudies-literature

A Very Uncommon Case of Pulmonary Hypertension.

Project description: Not available

| S-EPMC6302032 | biostudies-literature

D-?-aspartyl residue exhibiting uncommon high resistance to spontaneous peptide bond cleavage.

Project description:Although L-amino acids were selected as main constituents of peptides and proteins during chemical evolution, D-aspartyl (Asp) residue is found in a variety of living tissues. In particular, D-?-Asp is thought to be stable than any other Asp isomers, and this could be a reason for gradual accumulation in abnormal proteins and peptides to modify their structures and functions. It is predicted that D-?-Asp shows high resistance to biomolecular reactions. For instance, less reactivity of D-?-Asp is expected to bond cleavage, although such information has not been provided yet. In this work, the spontaneous peptide bond cleavage was compared between Asp isomers, by applying real-time solution-state NMR to eye lens ??-crystallin 51-60 fragment, S(51)LFRTVLD(58)SG(60) and ??-crystallin 61-67 analog, F(61)D(62)TGLSG(67) consisting of L-?- and D-?-Asp 58 and 62, respectively. Kinetic analysis showed how tough the uncommon D-?-Asp residue was against the peptide bond cleavage as compared to natural L-?-Asp. Differences in pKa and conformation between L-?- and D-?-Asp side chains were plausible factors to determine reactivity of Asp isomers. The present study, for the first time, provides a rationale to explain less reactivity of D-?-Asp to allow abnormal accumulation.

| S-EPMC4753488 | biostudies-literature

Thrombosis of a biological pulmonary valve in a young patient on anticoagulant therapy with rivaroxaban: a case report.

Project description:BackgroundPatients with repaired tetralogy Fallot often develop severe pulmonary regurgitation (PR) and need surgical or catheter valve replacement/implantation. Early valve failure is not expected and thrombosis of a biological valve in a mid-term period after surgery on pulmonary position is rare.Case summaryWe report a 33-year-old female patient, who presented with heart failure, 18 months after surgical implantation of a biological valve on pulmonary position for severe PR, after previous complete repair. The patient was on anticoagulant therapy with novel oral anticoagulants (NOACs) for paroxysmal atrial fibrillation. After revealing a big pulmonary valve (PV) thrombus as a cause of severe valve stenosis and right heart failure, patient was re-operated without complication. After surgery a long-term warfarin therapy was introduced. The patient had an uneventful 9-month follow-up.DiscussionThrombotic events after rivaroxaban therapy are rare in non-valvular disease and there is paucity of data for NOAC therapy related to valve thrombosis. In our case, severe heart failure 1 year and a half after PV replacement, in a patient taking anticoagulant therapy, was unexpected. The diagnosis of valve thrombosis was revealed by echocardiography, and confirmed by computed tomography. We did not find any sign of thrombophilia, or any mechanical reason for valve thrombosis.

| S-EPMC6439391 | biostudies-literature

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