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Cardiac tamponade secondary to subacute haemorrhage: case report. A 66-year-old man developed cardiac tamponade secondary to subacute haemorrhage during treatment with dabigatran etexilate and edoxaban as an anticoagulants [routes not stated]. The man was hospitalised for catheter ablation for symptomatic paroxysmal atrial fibrillation. He had a history of diabetes mellitus for which he was receiving unspecified hypoglycaemic agents. He also received edoxaban 60mg daily as a prophylaxis for thromboembolic events. On the day of the catheter ablation, edoxaban was switched to dabigatran-etexilate [dabigatran] 350mg daily. He underwent uneventful procedure. After 2 days of the procedure, he was discharged with edoxaban therapy. After 29 days of the procedure, chest x-ray was unremarkable. Subsequently, in ambulatory care he progressed satisfactorily. However, 90 days after the procedure, he presented with sudden chest discomfort. Auscultation, electrocardiograph and blood analysis demonstrated normal findings. The transthoracic echocardiography (TTE) revealed 11mm pericardial effusion at the anterior side of the right ventricle at end-diastole and 17mm pericardial effusion at the posterior side of the left ventricle. The M-mode echocardiographic evaluation at the apical 4-chamber view revealed collapse of the right atrium at both diastole and systole. After 5 days, he underwent cardiac CT. Immediately after the cardiac CT, he developed dyspnea and worsening chest pain. His BP was 90/54mm Hg, respiratory rate 26 breaths/minute, pulse rate 154 beats/minute of irregular (AF) rhythm and oxygen saturation at room air of 98%. The Chest xray revealed enlarged cardiac silhouette. The cardiac CT demonstrated 25-30mm pericardial effusion around the left atrium and ventricle, which had increased compare to 5 days before. The blood analysis revealed declined haemoglobin to 9.8 g/dL from 11.8 g/dL, positive high-sensitive troponin I 29.9 pg/L. He underwent urgent pericardiocentesis and effusion of 600mL was removed. The effusion was drained smoothly without clots. The effusion was bloody with haemoglobin 14.1 g/dL. A smear showed aggregated macrophages with hemosiderin which indicated recent haemorrhage. On the basis of aforementioned findings, he was diagnosed with delayed cardiac tamponade secondary to subacute haemorrhage. The man was admitted and the edoxaban was stopped. He was continued on pericardial drainage. On the day 2 of admission, 300mL of effusion was collected and the haemoglobin concentration of the effusion lowered to 3.1 g/dL. On day 3 of admission, he had no effusion and therefore, the catheter was removed. On day 1 and day 4 of admission, he received paracetamol [acetaminophen] for pain of drainage wound. After the removal of catheter, TTE revealed no effusion and his symptoms recovered completely. On day 4 of admission, sponataneouly the atrial fibrillation returned to sinus rhythm. Subsequently, he was started on edoxaban and on day 9 of admission, he was discharged. After 1 month from discharge, chest x