title: Spontaneous Hemopericardium in a Patient Receiving Apixaban Therapy: First Case Report.
abstract: Apixaban, a direct factor Xa inhibitor, is a novel oral anticoagulant (NOAC) indicated for prevention of embolic events in patients with nonvalvular atrial fibrillation. The agent is associated with a lower risk of bleeding compared with vitamin K antagonists such as warfarin. Hemopericardium is a life-threatening bleeding event that is rarely caused by anticoagulants. We describe the case of a 76-year-old woman who was diagnosed with nonvalvular atrial fibrillation and treated with apixaban. Six weeks later, she was hospitalized after complaints of weakness and dizziness, and a chest radiograph revealed cardiomegaly. Further imaging, including a computed tomography scan and transthoracic echocardiogram, confirmed a diagnosis of hemopericardium. To our knowledge, this is the first case report of hemopericardium associated with apixaban therapy. This report, along with two previous cases reports of hemopericardium associated with dabigatran and rivaroxaban, emphasizes the need for careful use of NOACs and for further research to identify an antidote or other method for controlling hemorrhage secondary to NOACs in an acute setting. Furthermore, clinicians should consider hemopericardium in the differential diagnosis of patients treated with anticoagulants, including NOACs, who present with cardiomegaly.
authors.affiliation: Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.|affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Chen
authors.initials: C
authors.lastname: Sigawy
authors.affiliation: affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Israel.|Radiology Department, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Sara
authors.initials: S
authors.lastname: Apter
authors.affiliation: Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.|affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Vine
authors.affiliation: Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.|affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000368:Aged; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010490:Pericardial Effusion / Q000139:chemically induced*; D011720:Pyrazoles / Q000009:adverse effects*; D011728:Pyridones / Q000009:adverse effects*
chemical_list: D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban
keywords: anticoagulation; atrial fibrillation; bleeding