PMID- 27577194 OWN - NLM STAT- MEDLINE DCOM- 20170621 LR - 20190112 IS - 1471-2261 (Electronic) IS - 1471-2261 (Linking) VI - 16 IP - 1 DP - 2016 Aug 30 TI - Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report. PG - 162 LID - 10.1186/s12872-016-0338-8 [doi] LID - 162 AB - BACKGROUND: Striking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks. This risk of bleeding is often underestimated when prescribing pharmacological agents such as DAPT and LMWH, designed to reduce ischaemic events following PCI in acute MI. Life-threatening haemorrhagic pericardial and pleural effusions not associated with access site bleeding are a rare example of such bleeding complications. CASE PRESENTATION: We report a case of a Bangladeshi male who developed cardiac tamponade resulting from haemorrhagic pericardial effusion as well as bilateral pleural effusions, 9 days after PCI with a DES, while on prasugrel and aspirin. He had presented late with inferior ST elevation myocardial infarction (STEMI), and was therefore also given enoxaparin initially. Haemorrhagic pericardial and pleural fluid were drained, and the patient was discharged on DAPT comprising of aspirin and clopidogrel. Following PCI to obtuse marginal, which was done as a staged procedure 6 months later, he was commenced on ticagrelor instead of clopidogrel. He developed no further bleeding complications over 1 year of follow up. CONCLUSION: Non-access site bleeding such as this, leading to haemorrhagic pericardial and pleural effusions can be rare and life-threatening. Furthermore, patients with acute coronary syndromes (ACS) have marked variation in their risk of major bleeding. Since haemorrhagic complications are associated with mortality, maintaining a balance between the risk of recurrent ischemia and that of bleeding is of paramount importance. The use of validated bleeding risk scores, careful monitoring of patients on DAPT with LMWH, or a switch over to agents with lesser risk of bleeding may reduce such complications. FAU - Cader, Fathima Aaysha AU - Cader FA AD - Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh. aaysha.cader@gmail.com. AD - National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. aaysha.cader@gmail.com. FAU - Haq, M Maksumul AU - Haq MM AD - Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh. FAU - Nasrin, Sahela AU - Nasrin S AD - Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh. FAU - Karim, Md Rezaul AU - Karim MR AD - Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh. LA - eng PT - Case Reports PT - Journal Article DEP - 20160830 PL - England TA - BMC Cardiovasc Disord JT - BMC cardiovascular disorders JID - 100968539 RN - 0 (Platelet Aggregation Inhibitors) RN - G89JQ59I13 (Prasugrel Hydrochloride) SB - IM MH - Cardiac Tamponade/diagnosis/*etiology/surgery MH - Coronary Angiography MH - Echocardiography MH - Humans MH - Male MH - Middle Aged MH - Percutaneous Coronary Intervention MH - Pericardial Effusion/chemically induced/*complications/diagnosis MH - Pericardiocentesis MH - Platelet Aggregation Inhibitors/administration & dosage/adverse effects MH - Prasugrel Hydrochloride/*adverse effects/therapeutic use MH - Radiography, Thoracic MH - ST Elevation Myocardial Infarction/diagnosis/*drug therapy/surgery PMC - PMC5006429 OTO - NOTNLM OT - Cardiac tamponade OT - Case report OT - Haemorrhage OT - Prasugrel EDAT- 2016/09/01 06:00 MHDA- 2017/06/22 06:00 PMCR- 2016/08/30 CRDT- 2016/09/01 06:00 PHST- 2016/03/19 00:00 [received] PHST- 2016/07/01 00:00 [accepted] PHST- 2016/09/01 06:00 [entrez] PHST- 2016/09/01 06:00 [pubmed] PHST- 2017/06/22 06:00 [medline] PHST- 2016/08/30 00:00 [pmc-release] AID - 10.1186/s12872-016-0338-8 [pii] AID - 338 [pii] AID - 10.1186/s12872-016-0338-8 [doi] PST - epublish SO - BMC Cardiovasc Disord. 2016 Aug 30;16(1):162. doi: 10.1186/s12872-016-0338-8.