Spontaneous hemopericardium with cardiac tamponade in a patient with myocardial infarction during multicomponent antithrombotic therapy

• Irina N. Suspitsyna
• Irina A. Sukmanova

Abstract

Prescribing multicomponent antithrombotic therapy is always difficult, as it is associated with a high hemorrhagic risk. If a patient with acute myocardial infarction who has undergone percutaneous coronary intervention with stenting of coronary arteries, the course of the disease is complicated by atrial fibrillation or a thrombosed aneurysm, there is a combination of high ischemic and hemorrhagic risks. We present a clinical case of the development of spontaneous hemopericardium complicated by cardiac tamponade while taking multicomponent antithrombotic therapy (double antiplatelet therapy and a vitamin K antagonist). Timely diagnosis of the complication, emergency pericardiocentesis un with evacuation of hemorrhagic effusion led to stabilization of the patient’s condition, and the absence of a thrombus according to Echo-CG data in dynamics, the possibility of replacing warfarin with oral anticoagulants according to new clinical guidelines, allowed for correction of anticoagulant therapy, and the patient was eventually discharged in a stable condition. The presented clinical example confirms the difficulties of maintaining an optimal risk/benefit balance when prescribing multicomponent antithrombotic therapy and determines the need for an individual approach to the management of this category of patients.

Keywords:acute myocardial infarction; left ventricular thrombus; atrial fibrillation; hemopericardium

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