Anticoagulation and Cardiac Tamponade: Is There a Relationship?

1Internal Medicine, Washington University School of Medicine, St. Louis, MO
2Oncology, Washington University School of Medicine, St. Louis, MO

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 22

Background:

A pervasive belief exists in medicine that anticoagulation increases the risk of cardiac tamponade in patients with known pericardial effusions, especially when the effusion is malignancy related (MR). To our knowledge, there are no published data examining whether anticoagulation or other bleeding risk factors are associated with cardiac tamponade or hemopericardium.

Methods:

A retrospective case‐control trial was conducted using data from the medical records of consecutive patients diagnosed with noniatrogenic pericardial effusions at Barnes Jewish Hospital (BJH) from January 1998 to April 2006. Comparative analysis using the chi‐square test was performed to identify differences between patients diagnosed with tamponade (cases) and those without tam‐ponade (controls). The rate of “anticoagulated” patients (defined as INR > 1.6, treatment with therapeutic dosing of a heparin product, or a platelet count < 50,000 cells/mm3) served as the primary outcome. Secondarily, presence of hemopericardium (based on a description of the pericardial fluid; or red blood cell count > 10,000 cells/mm3) was identified in patients who underwent drainage of pericardial fluid.

Results:

Data were analyzed from 125 patients with cardiac tamponade (53 [42.4%] MR) and 60 patients with pericardial effusions and no evidence of tamponade (30 [50%] MR). There was no significant difference between the tamponade and nontamponade patients in the proportion of patients defined as “anticoagulated” (37 of 125 [29.6%] tamponade patients vs. 18 of 60 [30%] nontamponade patients; P = .96). Analysis of MR patients alone revealed similar results (14 of 53 [26.4%] vs. 11 of 30 [36.6%] for tamponade and nontamponade patients, respectively; P = .33). Additionally, no differences were found between these groups in the individually examined bleeding risk factors, including thrombocytopenia, elevated INR or PTT, and use of anticoagulant or antiplatelet agents. “Anticoagulated” patients did not have a higher percentage of hemopericardium compared with patients without identified bleeding risk factors (24 of 34 [70.5%] vs. 26 of 43 [60.4%], respectively; P = .36).

Conclusions:

In this retrospective trial of patients with noniatrogenic pericardial effusions at BJH, there were no differences found between tamponade and nontamponade patients in the examined bleeding risk factors. The proportion of “anticoagulated“ patients with hemopericardium did not differ with the proportion of patients without identified bleeding risk factors with hemopericardium.

Author Disclosure:

B. Faller, none; J. Picus, none.

To cite this abstract:

Faller B, Picus J. Anticoagulation and Cardiac Tamponade: Is There a Relationship?. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 22. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/anticoagulation-and-cardiac-tamponade-is-there-a-relationship/. Accessed November 13, 2019.

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