Stöllberger Claudia, Heger Maria, Finsterer Josef
Krankenanstalt Rudolfstiftung, Wien, Austria.
Blood Coagul Fibrinolysis. 2017 Mar;28(2):185-188. doi: 10.1097/MBC.0000000000000553.
Spontaneous hemopericardium is a complication of anticoagulant therapy with not only vitamin-K-antagonists, but also with nonvitamin-K-antagonist oral anticoagulants. We report a polymorbid 75-year old male under a therapy with dabigatran, valsartan, amlodipine, nicorandil, furosemide, atorvastatin, bisoprolol, metformin, tizanidine, pantoprazole, and tramadol. He suffered from chest pain for 4 months. Coronary angiography showed only ectatic coronary arteries. He started taking nonsteroidal anti-inflammatory drugs. He was hospitalized because of dyspnea starting 10 days before admission, melena, and renal failure. Hemopericardium was diagnosed and pericardiocentesis yielded 2000 ml hemorrhagic fluid. Review of previous echocardiograms showed a 4 mm echo-free space, epicardial fat or pericardial effusion. A small (<10 mm) echo-free space in a patient on anticoagulant therapy should not be considered as trivial, but additional imaging studies should be carried out. If a pericardial effusion is newly diagnosed in a patient during anticoagulant therapy, the pharmacotherapy should be revised concerning potentially interacting drugs, like nonsteroidal anti-inflammatory drugs, and dosage of the anticoagulant drug. Vitamin-K-antagonists with their possibility of laboratory monitoring and availability of an antidote should be preferred over nonvitamin-K-antagonist oral anticoagulants.
自发性心包积血是抗凝治疗的一种并发症，不仅与维生素K拮抗剂有关，也与非维生素K拮抗剂口服抗凝药有关。我们报告一例75岁的多病男性患者，正在接受达比加群、缬沙坦、氨氯地平、尼可地尔、呋塞米、阿托伐他汀、比索洛尔、二甲双胍、替扎尼定、泮托拉唑和曲马多治疗。他胸痛4个月。冠状动脉造影仅显示冠状动脉扩张。他开始服用非甾体抗炎药。因入院前10天开始出现呼吸困难、黑便和肾衰竭而住院。诊断为心包积血，心包穿刺抽出2000毫升血性液体。回顾之前的超声心动图显示有一个4毫米的无回声区、心外膜脂肪或心包积液。接受抗凝治疗的患者中出现小的（<10毫米）无回声区不应被视为无关紧要，而应进行额外的影像学检查。如果在抗凝治疗期间患者新诊断出心包积液，应针对潜在相互作用的药物（如非甾体抗炎药）和抗凝药物的剂量调整药物治疗方案。与非维生素K拮抗剂口服抗凝药相比，维生素K拮抗剂因其可进行实验室监测且有解毒剂可用，应优先选用。
