Rebound warfarin toxicity presenting
with spontaneous hemopericardium
in cardiac tamponade: a case report
Dublin Core
Title
Rebound warfarin toxicity presenting
with spontaneous hemopericardium
in cardiac tamponade: a case report
with spontaneous hemopericardium
in cardiac tamponade: a case report
Subject
Hemopericardium, Cardiac tamponade, Rebound warfarin toxicity, Half-life
Description
Abstract
Background The spontaneous hemopericardium due to warfarin toxicity is uncommon but can be fatal if it leads to
cardiac tamponade and timely interventions are not administered.
Case presentation An 80-year-old male with a medical history of hypertension, chronic obstructive pulmonary
disease (COPD), and atrial fibrillation presented with chest pain and shortness of breath. On examination, he had
tachycardia, hypotension, and muffled heart sounds. The 2-D echocardiogram confirmed pericardial effusion
with cardiac tamponade. An emergent pericardiocentesis was performed in the emergency department (ED),
following which the patient hemodynamically improved. The past medical history was significant for recurrent
ED visit with warfarin toxicity in the form of calf hematoma. His most recent ED visit was three days ago, where
he received fresh frozen plasma (FFP) for a supra-therapeutic International Normalized Ratio (INR) of 8.66 without
bleeding manifestations and was discharged with an INR value of 2.27. During the current ED presentation, the
hemopericardium was likely due to rebound warfarin toxicity, as the INR reported was found to be 6.38 despite
having previously corrected to 2.27 and discontinuing warfarin after the recent ED discharge. In the current ED
presentation, coagulopathy was corrected with FFP and vitamin K. The patient was admitted to the ward for
evaluation. The pericardial fluid analysis showed no evidence of tuberculosis or other infections, and his recovery was
uneventful. On follow-up after 3 months, he was doing well on dabigatran for stroke prevention.
Conclusion The treatment of warfarin toxicity requires consideration of the half-life of the offending agent, warfarin,
as well as the antidotes (FFP and vitamin k) widely practiced in low-middle income countries to prevent rebound
warfarin toxicity.
Keywords Hemopericardium, Cardiac tamponade, Rebound warfarin toxicity, Half-life
Background The spontaneous hemopericardium due to warfarin toxicity is uncommon but can be fatal if it leads to
cardiac tamponade and timely interventions are not administered.
Case presentation An 80-year-old male with a medical history of hypertension, chronic obstructive pulmonary
disease (COPD), and atrial fibrillation presented with chest pain and shortness of breath. On examination, he had
tachycardia, hypotension, and muffled heart sounds. The 2-D echocardiogram confirmed pericardial effusion
with cardiac tamponade. An emergent pericardiocentesis was performed in the emergency department (ED),
following which the patient hemodynamically improved. The past medical history was significant for recurrent
ED visit with warfarin toxicity in the form of calf hematoma. His most recent ED visit was three days ago, where
he received fresh frozen plasma (FFP) for a supra-therapeutic International Normalized Ratio (INR) of 8.66 without
bleeding manifestations and was discharged with an INR value of 2.27. During the current ED presentation, the
hemopericardium was likely due to rebound warfarin toxicity, as the INR reported was found to be 6.38 despite
having previously corrected to 2.27 and discontinuing warfarin after the recent ED discharge. In the current ED
presentation, coagulopathy was corrected with FFP and vitamin K. The patient was admitted to the ward for
evaluation. The pericardial fluid analysis showed no evidence of tuberculosis or other infections, and his recovery was
uneventful. On follow-up after 3 months, he was doing well on dabigatran for stroke prevention.
Conclusion The treatment of warfarin toxicity requires consideration of the half-life of the offending agent, warfarin,
as well as the antidotes (FFP and vitamin k) widely practiced in low-middle income countries to prevent rebound
warfarin toxicity.
Keywords Hemopericardium, Cardiac tamponade, Rebound warfarin toxicity, Half-life
Creator
Ugyen Rinzin1* and Mahesh Gurung2
Source
https://doi.org/10.1186/s12245-025-01037-5
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Ugyen Rinzin1* and Mahesh Gurung2, “Rebound warfarin toxicity presenting
with spontaneous hemopericardium
in cardiac tamponade: a case report,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12874.
with spontaneous hemopericardium
in cardiac tamponade: a case report,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12874.