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Anticoagulants/edoxaban/heparin Pericardial bleeding and cardiac tamponade: 15 case reports

In a retrospective study of 2406 patients, conducted between January 2007 to December 2018 in Japan, 12 men and 3 women [14 patients aged between 53–82 years; age of remaining one patient not stated] were described, who developed life-threatening cardiac tamponade and pericardial bleeding during anticoagulant treatment with dabigatran etexilate, rivaroxaban, apixaban, edoxaban, heparin or warfarin for catheter ablation in atrial fibrillation [not all dosages stated; exact duration of treatments to reaction onsets not stated]. The patients, who had paroxysmal atrial fibrillation (6 patients), persistent atrial fibrillation (5 patients), long-standing persistent atrial fibrillation (2 patients) and atrial fibrillation (2 patients), were admitted for contact force-catheter system ablation, cryoballoon ablation or irrigated catheter ablation. Approximately 3–4 weeks prior to the ablation procedure, the patients started receiving anticoagulant treatment with oral apixaban 2.5–5mg two times a day (6 patients), oral dabigatran etexilate [dabigatran] 110–150mg two times a day (4 patients), oral rivaroxaban 10 mg/day (1 patient), oral edoxaban 30 mg/day (2 patients) and oral warfarin (2 patients). Of the 15 patients, 14 patients received unspecified sedatives for mild sedation, and the procedure was performed, while they were conscious. Concomitantly, the patients received bolus heparin infusion during the procedure. However, the patients developed a systolic BP