Spontaneous hemopericardium with dabigatran etexilate

A 66-year-old male who presented to ED with chest pain associated with shortness of breath. At presentation, he was found to be in atrial fibrillation (A-fib) with rapid ventricular rate (RVR). A-fib converted spontaneously to normal sinus rhythm (NSR). However, he remained tachycardic, hypo-tensive and dyspneic. A stat chest computed tomography scan (CT) was performed and showed large pericardial effusion with Hounsfield units of 12 in the anterior pocket and 21 in the posterior pocket. A beside echocardiography was performed, and was consistent with cardiac tamponade. Pt was taken emergently to cardiac catheterization lab for pericardiocentesis. 500 cc of hemorrhagic pericardial fluid was aspirated, and hemodynamics improved immediately. Approximately 2 weeks prior to the admission, the patient had been started on dabigatran etexilate (Pradaxa) for newly diagnosed non-valvular paroxysmal atrial fibrillation.