Cardiac tamponade due to apixaban therapy in patient with unknown pericardial hemangioma

A 78-year-old woman was hospitalized, in our Pulmonology Department, for worsening of resting dyspnea. She had a recent history of pulmonary embolism secondary to deep vein thrombosis. She was also affected by arterial hypertension in therapy with delapril/indapamide 30/2.5 mg OD. For the recent pulmonary embolism and the thrombosis, she was initially treated for 25 days with enoxaparin [8000 UI s.c. BD--the dosage of LMWH was assessed according to the patients constitution; weight 67 kg; renal function index (eGFR) 112 ml/min per 1.73 m2] and, 5 days before the onset of respiratory symptoms, she started apixaban (5 mg 2 cpr BD) with the creation of the therapeutic plan according to the national health rules, after having completed an instrumental follow-up with chest X-ray study and a perfusion lung scan.