# 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.

## Key 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.