Acute cardiac tamponade requires urgent diagnosis and treatment. We report a case of a 43-year-old man who was receiving warfarin treatment for 8 months following mitral valve replacement. The patient had complaint of dyspnea and fatigue for a few days. Cardiac tamponade was diagnosed, and the INR at that time was 10.4. Urgent pericardiocentesis were undertaken and 1400 ml of pericardial blood was drained. Following surgery the patient’s recovery was uneventful. An intravenous vitamin K injection and fresh frozen plasma transfusion were administered to reverse the patient’s over-anticoagulated state. The final pathology revealed chronic inflammation and there was no malignancy, and no bacteria or mycobacterium were seen. Emergency physicians should remember that over-anticoagulation with warfarin may contribute to certain complications, including hemopericardium, and that strict control of target INR should be the goal for patients who require continuous warfarin treatment.
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