Transl Clin Pharmacol.  2017 Sep;25(3):138-140. 10.12793/tcp.2017.25.3.138.

Hemorrhagic pericarditis associated with rivaroxaban in an atrial fibrillation patient with pacemaker

• Rhew SH
• Kim SS

• KMID: 2390933
• DOI: http://doi.org/10.12793/tcp.2017.25.3.138

Abstract

Rivaroxaban is a new oral anticoagulant used for the prevention of stroke in patients with atrial fibrillation. Hemorrhagic pericarditis is known to occur with rivaroxaban; however, only a few case reports in the literature describe such events. Recently, we experienced hemorrhagic pericarditis that treated with rivaroxaban for anticoagulation of newly diagnosed, non valvular AF patients with pacemaker. An 83 year old male with permanent pacemaker receiving rivaroxaban 20 mg daily once for 3 months presented at our emergency department complaining of exertional dyspnea. ECG showed intermittent atrial pacing failure and echocardiography showed large amount of pericardial effusion. After urgent pericardiocentesis, which resulted in removal of 500cc bloody fluid, there was an immediate and dramatic improvement in the patient's clinical state. He was discharged without anticoagulation therapy due to concern for further bleeding. This case highlight the potential for bleeding complications associated with novel anticoagulants. Rivaroxaban is being used with increasing frequently in outpatient care. However, no available laboratory test specifically measures the anticoagulant effect of rivaroxaban. Also, in the events of serious bleeding, no specific antidotes, reversal agents were available. Clinicians should be aware of the possibility of hemopericardium in patients treated with anticoagulants, including rivaroxaban who presented with cardiomegaly.

Keyword

Atrial fibrillation; Novel oral anticoagulant; Pericarditis

MeSH Terms

Ambulatory Care
Anticoagulants
Antidotes
Atrial Fibrillation*
Cardiomegaly
Dyspnea
Echocardiography
Electrocardiography
Emergency Service, Hospital
Hemorrhage
Humans
Male
Pericardial Effusion
Pericardiocentesis
Pericarditis*
Rivaroxaban*
Stroke
Anticoagulants
Antidotes
Rivaroxaban

Figure

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  Figure 1 Electrocardiography (ECG) showed intermittent pacing artifacts without capture.

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  Figure 2 Transthoracic ECG showed a large amount of pericardial effusion (A), which had not been demonstrated 3 months before (B).

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  Figure 3 Chest radiography showed that the pacing leads were in appropriate positions (A) compared with 3 months before (B).

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  Figure 4 Cardiac computed tomography scans showed that both atrial leads (A) and ventricular leads (B) were in the cardiac chamber.

Reference

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