Hemopericardium in the Setting of Direct Oral Anticoagulant Use: An Updated Systematic Review

Cardiovasc Revasc Med. 2022 Jun:39:73-83. doi: 10.1016/j.carrev.2021.09.010. Epub 2021 Sep 29.


Background: Spontaneous hemopericardium, associated with direct oral anticoagulant (DOAC) use, is one of the uncommon complications with high morbidity that has not been extensively studied We aimed to determine demographic characteristics, clinical features, lab evaluation, management, and outcomes of the studies focusing on hemopericardium as a DOAC use.

Methods: PubMed, Web of Science, Google Scholar, and CINAHL databases were searched for relevant articles using MeSH key-words and imported into referencing/review software. The data regarding demographics, clinical characteristics, cardiac investigations, and management were analyzed in IBM Statistics SPSS 21. t-Test and Chi-square test were used. A P score of <0.05 was considered statistically significant.

Results: After literature search, a total of 41 articles were selected for analysis. The mean age of the patients was 70.09 ± 11.06 years (p < 0.05); the majority of them were males (58.5%). Most of the patients presented with shortness of breath (75.2%) and had more than 3 co-morbid conditions (43.9%). The most frequently used anticoagulant was rivaroxaban (15/41; 36.6%); the common indication being arrhythmia (78.0%). CYP4503A4/P-Gp inhibitors (22.2%) were commonly used by the patients. Majority of the cases had a favorable outcome (95.1%). Pericardial tamponade was noted in 31/41 cases. Pericardiocentesis was performed in 37/41 cases.

Conclusions: Hemopericardium from DOAC use has a favorable outcome but requires urgent pericardiocentesis. However, long term mortality, monitoring of DOAC activity, and drug-drug interactions have not been widely studied.

Keywords: CYP4503A4; Class C drugs; DOAC; Hemopericardium; Interactions; P-gp inhibitors.

Publication types

  • Systematic Review

MeSH terms

  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anticoagulants* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pericardial Effusion* / chemically induced
  • Pericardial Effusion* / diagnostic imaging
  • Pericardial Effusion* / therapy
  • Pericardiocentesis
  • Rivaroxaban


  • Anticoagulants
  • Rivaroxaban