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Ann Thorac Surg 2006;82:1090-1091
© 2006 The Society of Thoracic Surgeons

Case report

Raised International Normalized Ratio: An Early Warning for a Late Cardiac Tamponade?

Ammad Shah, MD, MBA*, Albert van den Brink, MD, Bas de Mol, MD, PhD

Academic Medical Center, Amsterdam, the Netherlands

Accepted for publication January 6, 2006.

* Address correspondence to Dr Shah, Cardiothoracic Surgery Dept, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ the Netherlands (Email: a.shah{at}amc.uva.nl).

Seven consecutive cases of late cardiac tamponade after valvular surgery are reported; all were postoperatively treated with acenocoumarol and 6 had an international normalized ratio peak greater than 6.0 within 3 days preceding tamponade. It is suggested that during this excessive anticoagulation state a hemorrhagic event within the pericardial space precipitates the tamponade. In addition, it is proposed that all valve patients with a postoperative international normalized ratio peak greater than 5.0 within 6 weeks postoperatively should be considered for a transthoracic echocardiogram.






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