SIMULTANEOUS PULMONARY EMBOLISM WITH CARDIAC TAMPONADE AND REPETITIVE ISCHEMIC STROKE AS VASCULAR COMPLICATIONS OF LUNG CANCER: A CASE REPORT AND SYSTEMATIC LITERATURE REVIEW.

It is known that patients with lung cancer have a considerably higher incidence of cardiovascular complications that lead to venous or arterial events, and malignant pericardial effusion can often be observed due to pericardial metastases. Simultaneous occurrence of cardiac tamponade and venous thromboembolism almost always happens in patients with lung malignancy. Our case report describes a patient with concurrent pulmonary embolism and cardiac tamponade as the initial manifestation of lung cancer, which, apart from pericardiocentesis and symptomatic therapy, was treated at long term with a direct oral anticoagulant (apixaban). Therapy was well tolerated by the patient and there were no bleeding complications related to primary disease and anticoagulant treatment. The course of the disease was complicated by repetitive strokes, which were treated with mechanical thrombectomy. Because of this scenario, a systematic review of the literature was conducted, listing all available case reports of patients with the simultaneous occurrence of cardiac tamponade and pulmonary embolism. In all patients, the underlying condition was lung malignancy, often as the first manifestation of the disease. This is a relatively rare event, and the approach to long-term treatment varied from case to case in the absence of valid guidelines. Our case demonstrated that, in the light of new studies and guidelines, apixaban represented a safe and effective treatment option even in patients at a high risk of bleeding.