Song Jessica, Jaradeh Mark, Xu William, Deluna Andres, Sevak Rajkumar J, Wang Clifford, Zhao Susan X
Department of Pharmacy Practice, University of the Pacific School of Pharmacy, PHS 299, Stockton, California, USA.
Department of Medicine, Santa Clara Valley Medical Center, San Jose, California, USA.
JACC Adv. 2025 Apr;4(4):101612. doi: 10.1016/j.jacadv.2025.101612. Epub 2025 Mar 17.
Pericardial effusion (PEff) has been described to occur in association with direct oral anticoagulant (DOAC).
The purpose of this study was to assess the incidence, characteristics, and predisposing factors of PEff associated with DOACs.
In this retrospective single center study, multivariable logistic regression analysis was used to identify factors associated with PEff in adult patients (age ≥18 years) in the Santa Clara Health System between 2013 and 2023.
Of the 456 patients with at least small to moderate PEff, 50 were on DOACs (DOAC PEff), 16 on warfarin (warfarin PEff), and 390 with no anticoagulation (NA PEff), with annual incidence 0.069%, 0.047%, and 0.001% for DOAC, warfarin, and NA PEff, respectively. Twenty-five (50%) of the DOAC PEff cases had moderately large or large PEff. Twenty-one cases underwent either percutaneous or surgical drainage. The DOAC PEff patients were significantly older and with more concurrent use of amiodarone. Logistic regression identified the following factors associated with moderately large or large PEff: DOAC (OR: 2.28; 95% CI: 1.19-4.37), warfarin (OR: 5.50; 95% CI: 1.88-16.06), concurrent use of amiodarone (OR: 4.32; 95% CI: 1.46-12.78), and presence of solid tumor (OR: 2.06; 95% CI: 1.25-3.39).
This is the largest single center case series of DOAC PEff, with annual incidence higher than previously reported. Future research is needed to study the pharmacokinetic interactions between DOACs and commonly co-prescribed drugs as well as the cost-effectiveness of enhanced surveillance of PEff in those with solid cancer while on DOACs.
心包积液（PEff）已被描述为与直接口服抗凝剂（DOAC）相关。
本研究的目的是评估与DOAC相关的心包积液的发生率、特征和易感因素。
在这项回顾性单中心研究中，采用多变量逻辑回归分析来确定2013年至2023年期间圣克拉拉卫生系统中成年患者（年龄≥18岁）与心包积液相关的因素。
在456例至少有轻度至中度心包积液的患者中，50例使用DOAC（DOAC心包积液），16例使用华法林（华法林心包积液），390例未进行抗凝（非抗凝心包积液），DOAC、华法林和非抗凝心包积液的年发生率分别为0.069%、0.047%和0.001%。25例（50%）DOAC心包积液病例有心包积液中度或大量。21例患者接受了经皮或手术引流。DOAC心包积液患者年龄明显更大，且更常同时使用胺碘酮。逻辑回归确定了以下与中度或大量心包积液相关的因素：DOAC（比值比：2.28；95%置信区间：1.19 - 4.37）、华法林（比值比：5.50；95%置信区间：1.88 - 16.06）、同时使用胺碘酮（比值比：4.32；95%置信区间：1.46 - 12.78）和实体瘤的存在（比值比：2.06；95%置信区间：1.25 - 3.39）。
这是最大的关于DOAC心包积液的单中心病例系列，年发生率高于先前报道。未来需要研究DOAC与常用联合处方药物之间的药代动力学相互作用，以及对接受DOAC治疗的实体癌患者加强心包积液监测的成本效益。
