Shastri Pinang, Bhuta Sapan, Oostra Carson, Monroe Todd
University of Toledo, 3000 Arlington Ave, Toledo, OH 43614, USA.
ProMedica Toledo Hospital, 2142 N Cove Blvd, Toledo, OH 43606, USA.
Eur Heart J Case Rep. 2020 Dec 11;5(1):ytaa482. doi: 10.1093/ehjcr/ytaa482. eCollection 2021 Jan.
The 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.
A 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.
While 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.
与维生素K拮抗剂相比，新型口服抗凝药的副作用（如颅内出血）发生率相对较低，因此在临床实践中的使用和效用不断增加，尤其是在老年人中。利伐沙班是一种Xa因子和凝血酶原酶抑制剂，用于非瓣膜性心房颤动的中风和静脉血栓栓塞预防以及静脉血栓栓塞的治疗。
一名服用利伐沙班的阵发性心房颤动患者出现全身不适、头晕和眩晕。尽管心肌酶无异常，但患者被发现处于严重的心源性休克状态。心电图显示心率控制的心房颤动，下侧壁导联T波倒置，无相关电交替。床边超声心动图显示大量心包积液，符合心脏压塞生理。抗凝逆转后，患者接受了紧急心包穿刺，抽出了血性液体，随后血流动力学状态得到改善。尽管之前腹部计算机断层扫描显示有腹膜后淋巴结病，且担心继发于淋巴瘤的潜在恶性积液，但液体细胞学检查未发现恶性细胞证据，后续流式细胞术和骨髓活检也无异常。
虽然心包积血未被列为利伐沙班已知的副作用，但文献中曾描述过利伐沙班继发心包积血的病例，继发于包括CYP450药物相互作用或心脏装置植入等易感危险因素。在本病例中，患者在服用利伐沙班时出现自发性心包积血，没有任何先前明确的危险因素或恶性肿瘤证据。
