Spontaneous Hemopericardium Associated With Apixaban Use With Newly Diagnosed Malignancy and Acute Kidney Injury: A Case Report

TL;DR

A patient taking apixaban for atrial fibrillation developed a rare bleeding complication called hemopericardium, likely due to kidney issues and a new cancer diagnosis.

Contribution

Reports a rare case of spontaneous hemopericardium linked to apixaban use in a patient with malignancy and kidney injury.

Findings

Apixaban use in a patient with renal malignancy and atrial fibrillation led to spontaneous hemopericardium.

The condition required a pericardial window for treatment.

This case highlights the risk of bleeding in patients with kidney injury and cancer on direct oral anticoagulants.

Abstract

Direct oral anticoagulants have simplified the use of anticoagulation for patients and clinicians. These medications now have indications for non-valvular atrial fibrillation and venous thromboembolism and carry a lower risk of bleeding than warfarin. While bleeding complications are common amongst all anticoagulants, spontaneous hemopericardium is a rarely reported side effect of direct oral anticoagulants, previously reported in patients with concomitant malignancy or kidney injury. We present a case of a patient with recently diagnosed renal malignancy and atrial fibrillation on apixaban who developed a spontaneous hemopericardium that required a pericardial window.

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