Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature

Yıl 2013, Cilt: 4 Sayı: 2, 229 - 233, 01.06.2013

Faruk Ertaş Nihat Polat Abdulkadir Yıldız Mustafa Oylumlu Mehmet Sıddık Ülgen

https://doi.org/10.5799/ahinjs.01.2013.02.0273

Öz

Acute cardiac tamponade requires urgent diagnosis and treatment. We report a case of a 43-year-old man who was receiving warfarin treatment for 8 months following mitral valve replacement. The patient had complaint of dyspnea and fatigue for a few days. Cardiac tamponade was diagnosed, and the INR at that time was 10.4. Urgent pericardiocentesis were undertaken and 1400 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 hemopericardium, and that strict control of target INR should be the goal for pa­tients who require continuous warfarin treatment. J Clin Exp Invest 2013; 4 (2): 229-233

Anahtar Kelimeler

Hemopericardium, tamponade, oral antico­agulation, warfarin, echocardiography

Antikoagülasyonun indüklediği hemoperikardiyumlu tamponad: Olgu sunumu ve literatür incelemesi

Öz

Akut kardiyak tamponad acil tanı ve tedavi gerektirir. Biz 43 yaşında, erkek ve mitral valv replasmanı sonrası sekiz aydır warfarin tedavisi alan bir olguyu aldık. Hastanın bir­kaç gündir başlayan nefes darlığı ve halsizlik şikayetikleri mevcuttu. Kardiyak tamponad tanısı konuldu ve 1400 ml mai perikardiyosentezle acil olarak drene edildi. Tanı sı­rasında İNR değeri çok yüksek olan hastaya Vitamin K antagonistleri ve taze donmuş plazma verilerek yuksek koagülasyon durumu geriye döndürüldü. Patolojik incele­me sonucunda enfeksiyon ve malingnensi saptanmadı. Hastada kronik inflamasyon düşünüldü. Sonuç olarak warfarin overdoz acil bir durum olup hemoperikardiyumla tamponada yol açabilmektedir. Bunun için warfarin teda­visi başlanılan hastalarda warfarin dozu ve hedef İNR de­ğerleri sıkı kontrol edilmelidir.

Anahtar Kelimeler

Warfarin, hemoperikardiyum, tampo­nad, İNR

Kaynakça

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