title: Massive, fatal, intracardiac thrombosis associated with prothrombin complex concentrate.
abstract: Prothrombin complex concentrates are frequently used to rapidly reverse anticoagulation with vitamin K antagonists associated with life-threatening bleeding. We report a patient receiving warfarin who presented to the emergency department with an international normalization ratio greater than 12.8 in cardiac tamponade and received prothrombin complex concentrate for rapid reversal of anticoagulation. On correction of the tamponade, the patient developed a massive and fatal right-sided ventricular thrombus. Thrombogenic complications of treatment with prothrombin complex concentrate have been reported before. Caution should be used when using prothrombin complex concentrates for reversal of anticoagulation.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA 94612, USA. Otis.warren@gmail.com
authors.forename: Otis
authors.initials: O
authors.lastname: Warren
authors.forename: Barry
authors.initials: B
authors.lastname: Simon
mesh_terms: D000368:Aged; D001779:Blood Coagulation Factors / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology; D003029:Coagulants / Q000009:adverse effects*; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects; D004357:Drug Synergism; D017809:Fatal Outcome; D006331:Heart Diseases / Q000139:chemically induced*; D006352:Heart Ventricles / Q000473:pathology; D006490:Hemostatics / Q000009:adverse effects; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010490:Pericardial Effusion / Q000188:drug therapy*; D011517:Prothrombin Time; D013927:Thrombosis / Q000139:chemically induced*
chemical_list: D001779:Blood Coagulation Factors; D003029:Coagulants; D006490:Hemostatics; C025667:prothrombin complex concentrates; D003894:Deamino Arginine Vasopressin