与阿哌沙班相关的出血性心脏压塞：一例报告及文献系统综述
Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and Systematic Review of Literature.
作者信息
Asad Zain Ul Abideen, Ijaz Sardar Hassan, Chaudhary Amna Mohyud Din, Khan Safi U, Pakala Aneesh
机构信息
University of Oklahoma Health Sciences Center, Oklahoma City, USA.
University of Oklahoma Health Sciences Center, Oklahoma City, USA.
出版信息
Cardiovasc Revasc Med. 2019 Nov;20(11S):15-20. doi: 10.1016/j.carrev.2019.04.002. Epub 2019 Apr 4.
BACKGROUND
Hemorrhagic cardiac tamponade (HCT) is characterized by rapid accumulation of blood in the pericardium causing hemodynamic collapse. We report a case of HCT due to Apixaban use in a patient with renal cell carcinoma, supplemented with a systematic review of pericardial tamponade associated with the use of direct oral anticoagulants (DOACs).
CASE REPORT
A 62-year-old African American male with a history of metastatic renal cell carcinoma presented with dyspnea while taking Apixaban. He was diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion was drained. The pericardial fluid analysis was negative for malignancy and suggestive of HCT. He had a complicated hospital course and died several days later.
METHODS
We searched MEDLINE, EMBASE and other sources for published cases of pericardial tamponade associated with DOACs. Our outcomes of interest included patient characteristics, risk factors, timing from the start of anticoagulation to tamponade, treatment and mortality. Simple descriptive statistics using percentages for categorical variables were used to describe the included cases.
RESULTS
A total of 26 cases were included in the final systematic review after searching MEDLINE, EMBASE and other sources. The mean age was 70 years (range 43-88) with 19 (73%) males. Twelve cases (46%) were associated with Rivaroxaban, 9 (37%) with Dabigatran and 5(19%) with Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine. Only 2 patients died but 24 had to undergo pericardiocentesis.
CONCLUSION
Cardiac tamponade is rarely associated with DOACs and elderly male patients with renal and coagulation abnormalities appear to have the highest risk.
背景
出血性心脏压塞（HCT）的特征是心包内血液迅速积聚，导致血流动力学崩溃。我们报告了一例因使用阿哌沙班导致HCT的肾细胞癌患者病例，并对与使用直接口服抗凝剂（DOACs）相关的心包压塞进行了系统综述。
病例报告
一名62岁有转移性肾细胞癌病史的非裔美国男性在服用阿哌沙班时出现呼吸困难。他被诊断为心包压塞，引流出血性积液800毫升。心包液分析未发现恶性肿瘤，提示为HCT。他的住院过程复杂，几天后死亡。
方法
我们在MEDLINE、EMBASE和其他来源中搜索与DOACs相关的心包压塞的已发表病例。我们感兴趣的结果包括患者特征、危险因素、从开始抗凝到发生压塞的时间、治疗和死亡率。使用分类变量的百分比进行简单描述性统计来描述纳入的病例。
结果
在搜索MEDLINE、EMBASE和其他来源后，最终的系统综述共纳入26例病例。平均年龄为70岁（范围43 - 88岁），其中19例（73%）为男性。12例（46%）与利伐沙班有关，9例（37%）与达比加群有关，5例（19%）与阿哌沙班有关。16例国际标准化比值（INR）升高，15例肌酐升高。只有2例患者死亡，但24例患者不得不接受心包穿刺术。
结论
心脏压塞很少与DOACs相关，老年男性且有肾脏和凝血异常的患者似乎风险最高。
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