Why the study?
Pericardial effusion has been reported in association with direct oral anticoagulants, but its incidence, characteristics, and predisposing factors remained to be defined.
Does DOAC use increase the risk and severity of pericardial effusion compared to warfarin or no anticoagulation in adult patients?
Does DOAC use increase the risk and severity of pericardial effusion compared to warfarin or no anticoagulation in adult patients?
DOAC use, particularly with concurrent amiodarone or in patients with solid tumors, is associated with an increased risk of developing moderately large or large pericardial effusions.
May raise suspicion for pericardial effusion in DOAC patients on amiodarone or with cancer; leaves open surveillance as hypothesis-generating only.
BACKGROUND: Pericardial effusion (PEff) has been described to occur in association with direct oral anticoagulant (DOAC). OBJECTIVES: The purpose of this study was to assess the incidence, characteristics, and predisposing factors of PEff associated with DOACs. METHODS: In this retrospective single center study, multivariable logistic regression analysis was used to identify factors associated with PEff in adult patients (age ≥18 years) in the Santa Clara Health System between 2013 and 2023. RESULTS: Of the 456 patients with at least small to moderate PEff, 50 were on DOACs (DOAC PEff), 16 on warfarin (warfarin PEff), and 390 with no anticoagulation (NA PEff), with annual incidence 0.069%, 0.047%, and 0.001% for DOAC, warfarin, and NA PEff, respectively. Twenty-five (50%) of the DOAC PEff cases had moderately large or large PEff. Twenty-one cases underwent either percutaneous or surgical drainage. The DOAC PEff patients were significantly older and with more concurrent use of amiodarone. Logistic regression identified the following factors associated with moderately large or large PEff: DOAC (OR: 2.28; 95% CI: 1.19-4.37), warfarin (OR: 5.50; 95% CI: 1.88-16.06), concurrent use of amiodarone (OR: 4.32; 95% CI: 1.46-12.78), and presence of solid tumor (OR: 2.06; 95% CI: 1.25-3.39). CONCLUSIONS: This is the largest single center case series of DOAC PEff, with annual incidence higher than previously reported. Future research is needed to study the pharmacokinetic interactions between DOACs and commonly co-prescribed drugs as well as the cost-effectiveness of enhanced surveillance of PEff in those with solid cancer while on DOACs.
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Jaradeh et al. (2025) studied this question.
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