Life-threatening pericardial bleed complicating atrial fibrillation ablation associated with edoxaban therapy successfully managed with prothrombin complex concentrate

The risk of pericardial bleeding complicating atrial fibrillation (AF) ablation is estimated to be around 0.5%–1%.1 The consequences may be exacerbated by the need for anticoagulation for prophylaxis of thromboembolism. Once-daily administered direct oral anticoagulants (DOACs) such as edoxaban can be safely continued uninterrupted at the time of AF ablation.2 However, management of bleeding complications in the context of DOAC therapy remains a challenge, especially as anti-factor Xa DOACs do not currently have licensed specific reversal agents.