Cinelli Michael, Uddin Asif, Duka Ilirjana, Soomro Armaghan, Tamburrino Frank, Ghavami Foad, Lafferty James
Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.
Department of Cardiology, Staten Island University Hospital, Staten Island, NY, USA.
Cardiol Res. 2019 Aug;10(4):249-252. doi: 10.14740/cr902. Epub 2019 Jul 31.
Direct oral anticoagulants (DOACs) are used for many conditions where anticoagulation is needed such as non-valvular atrial fibrillation, deep vein thrombosis (DVT) and pulmonary embolism (PE). These novel agents have become popular since they do not require monitoring of therapeutic levels and there is a lower risk of certain bleeding complications when compared to warfarin. However, the efficacy and side effect profile of these agents have not been widely studied in certain patient cohorts, namely cancer patients and patients on immunomodulators or hormone analogs. We present a case of a patient with a history of malignancy and autoimmune disease who developed pericardial and pleural effusions shortly after initiating apixaban for treatment of a PE. In addition, we aim to increase awareness of the role that the newly available reversal agents for anticoagulants would offer in the acute management of hemorrhagic pericardial and pleural effusions caused by DOACs in patients with and without malignancy.
直接口服抗凝剂（DOACs）用于许多需要抗凝的情况，如非瓣膜性心房颤动、深静脉血栓形成（DVT）和肺栓塞（PE）。这些新型药物已变得很受欢迎，因为它们不需要监测治疗水平，并且与华法林相比，某些出血并发症的风险更低。然而，这些药物的疗效和副作用在某些患者群体中尚未得到广泛研究，即癌症患者以及使用免疫调节剂或激素类似物的患者。我们报告一例有恶性肿瘤和自身免疫性疾病病史的患者，在开始使用阿哌沙班治疗肺栓塞后不久出现心包和胸腔积液。此外，我们旨在提高人们对于新可用的抗凝剂逆转剂在有或无恶性肿瘤的患者中急性处理由DOACs引起的出血性心包和胸腔积液时所起作用的认识。
