title: Raised international normalized ratio: an early warning for a late cardiac tamponade?
abstract: Seven consecutive cases of late cardiac tamponade after valvular surgery are reported; all were postoperatively treated with acenocoumarol and 6 had an international normalized ratio peak greater than 6.0 within 3 days preceding tamponade. It is suggested that during this excessive anticoagulation state a hemorrhagic event within the pericardial space precipitates the tamponade. In addition, it is proposed that all valve patients with a postoperative international normalized ratio peak greater than 5.0 within 6 weeks postoperatively should be considered for a transthoracic echocardiogram.
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands. a.shah@amc.uva.nl
authors.forename: Ammad
authors.initials: A
authors.lastname: Shah
authors.forename: Albert
authors.initials: A
authors.lastname: van den Brink
authors.forename: Bas
authors.initials: B
authors.lastname: de Mol
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004322:Drainage; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D000074:Acenocoumarol