Olagunju Abdulbaril, Khatib Mohammad, Palermo-Alvarado Frances
Internal Medicine, Creighton University School of Medicine, Phoenix, USA.
Cureus. 2021 Feb 22;13(2):e13486. doi: 10.7759/cureus.13486.
According to the ARISTOTLE trial, apixaban was superior to warfarin because it was associated with fewer strokes, systemic embolism, and bleeding. Hemopericardium was one of the major bleeding events reported in this trial. However, the percentage of patients that developed hemopericardium was not stated in the trial results. We present a case of hemopericardium in an 80-year-old man admitted for dyspnea, cough, and lower extremity edema. He was recently diagnosed with paroxysmal atrial fibrillation and started on apixaban for stroke prevention. Prior to admission, he was taking metoprolol succinate and amiodarone for atrial fibrillation. His symptoms resolved after undergoing successful pericardiocentesis. Although hemopericardium is a rare side effect associated with the use of non-vitamin K oral anticoagulants (NOACs), we suspect that a drug-drug interaction between apixaban and amiodarone (via the cytochrome p450 system and p-glycoprotein efflux pumps), the patient's advanced age, and borderline creatinine are possible risk factors.
根据ARISTOTLE试验，阿哌沙班优于华法林，因为它与更少的中风、全身栓塞和出血相关。心包积血是该试验报告的主要出血事件之一。然而，试验结果中未说明发生心包积血的患者百分比。我们报告一例80岁男性因呼吸困难、咳嗽和下肢水肿入院，被诊断为心包积血的病例。他最近被诊断为阵发性心房颤动，并开始服用阿哌沙班预防中风。入院前，他正在服用琥珀酸美托洛尔和胺碘酮治疗心房颤动。在成功进行心包穿刺术后，他的症状得到缓解。尽管心包积血是使用非维生素K口服抗凝剂（NOACs）罕见的副作用，但我们怀疑阿哌沙班与胺碘酮之间的药物相互作用（通过细胞色素p450系统和P-糖蛋白外排泵）、患者的高龄以及临界肌酐水平可能是危险因素。
