Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 454–458 | Cite as

Concurrent presentation of a hemorrhagic pericardial effusion and venous thromboembolism in malignancy: a systematic review of case studies

  • Krishna Pabba
  • Cristhiam M. Rojas-HernandezEmail author


The concurrent presentation of symptomatic malignant pericardial hemorrhage and venous thromboembolism is a rare event that poses a clinical dilemma. Existing VTE guidelines do not indicate when, or if, anticoagulation therapy should be started after the treatment of the pericardial bleed. We performed a systematic review to compile the published clinical evidence on the occurrence of coexisting pericardial hemorrhage and VTE in cancer patients and to describe the clinical presentations and bleeding and thrombosis outcomes before and after anticoagulation therapy. We studied published case reports on patients with cancer who presented to the hospital with pericardial hemorrhage and VTE through April 11, 2019. We found seven published case reports. All patients had suffered from a pulmonary embolism and had pericardiocentesis during hospitalization. Five patients (71%) had lung cancer. Four patients (57%) were started on anticoagulation after pericardial drainage and survived the index event. Two patients (29%) were not started on anticoagulation after pericardiocentesis; only one of these patients survived the hospitalization. Pericardial bleeding risk in cancer may be inherent to malignancy, and it is unclear if anticoagulation use increases the risk of recurrent pericardial bleeding. The management of pericardial bleeding typically requires pericardiocentesis, and clinical registries, prospective collaboration projects, and case adjudication are needed to establish the safety of initiation of antithrombotic therapy in such patients.


Malignancy Venous thromboembolism Pericardial effusion Pulmonary embolism Hemorrhage 


Author contributions

KP designed and performed the research and also wrote the manuscript. CMR-H also designed, performed the research, and revised the manuscript.

Compliance with ethical standards

Conflicts of interest

Dr. Rojas-Hernandez has received funding from Daichii-Sankyo clinical research with oral anticoagulants in cancer associated venous thrombosis. Dr Pabba has no competing interests to declare.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineMcGovern Medical School at The University of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Section of Benign HematologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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