Nihat POLAT, Mehmet Sıddık ÜLGEN, Abdulkadir YILDIZ, Faruk ERTAŞ, Mustafa OYLUMLU

Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature

Akut kardiyak tamponad acil tanı ve tedavi gerektirir. Biz 43 yaşında, erkek ve mitral valv replasmanı sonrası sekiz aydır warfarin tedavisi alan bir olguyu aldık. Hastanın bir-kaç gündir başlayan nefes darlığı ve halsizlik şikayetikleri mevcuttu. Kardiyak tamponad tanısı konuldu ve 1400 ml mai perikardiyosentezle acil olarak drene edildi. Tanı sı-rasında İNR değeri çok yüksek olan hastaya Vitamin Kantagonistleri ve taze donmuş plazma verilerek yuksekkoagülasyon durumu geriye döndürüldü. Patolojik incele-me sonucunda enfeksiyon ve malingnensi saptanmadı.Hastada kronik inflamasyon düşünüldü. Sonuç olarakwarfarin overdoz acil bir durum olup hemoperikardiyumlatamponada yol açabilmektedir. Bunun için warfarin teda-visi başlanılan hastalarda warfarin dozu ve hedef İNR de- ğerleri sıkı kontrol edilmelidir.

Antikoagülasyonun indüklediği hemoperikardiyumlu tamponad: Olgu sunumu ve literatür incelemesi

Acute cardiac tamponade requires urgent diagnosis andtreatment. We report a case of a 43-year-old man whowas receiving warfarin treatment for 8 months followingmitral valve replacement. The patient had complaint ofdyspnea and fatigue for a few days. Cardiac tamponadewas diagnosed, and the INR at that time was 10.4. Urgentpericardiocentesis were undertaken and 1400 ml of pericardial blood was drained. Following surgery the patient’s recovery was uneventful. An intravenous vitamin K injec- tion and fresh frozen plasma transfusion were adminis- tered to reverse the patient’s over-anticoagulated state.The final pathology revealed chronic inflammation andthere was no malignancy, and no bacteria or mycobacte-rium were seen. Emergency physicians should rememberthat over-anticoagulation with warfarin may contribute tocertain complications, including hemopericardium, andthat strict control of target INR should be the goal for pa-tients who require continuous warfarin treatment.

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