Hemopericardium Complicating Acute Myocardial Infarction

To the Editor:

I read with interest Nemeth and associates' case report, with very nice illustrations, of hemopericardium after myocardial infarction. ¹ Yet the authors did not discuss the probable role of abciximab in the pathogenesis of hemopericardium in this patient.

Prior to the thrombolytic era, hemopericardium was a rare complication of acute myocardial infarction. ² Since the introduction of thrombolytic therapy and platelet glycoprotein IIb/IIIa antagonists for acute myocardial infarction, hemopericardium with or without cardiac tamponade has been reported more frequently. ^3–5 Because the use of these agents and anticoagulants has become increasingly common, this case of hemopericardium ¹ should serve as a reminder of a rare but serious complication of acute myocardial in farction that requires prompt recognition and life-saving intervention.

On the other hand, the benefits of thrombolytic therapy in acute myocardial infarction have been well established and far outweigh the small risk of hemopericardium. As a matter of fact, the once common Dressler syndrome ⁶ (recurrent post-myocardial infarction pericarditis) has largely disappeared since the introduction of thrombolytic therapy ⁷—although the decreased use of oral anticoagulants in acute myocardial infarction and the prompt treatment of early post-myocardial infarction pericarditis may also play a role. ^7,8