To the Editor.—
The article by Belie and colleagues on cardiac tamponade during anticoagulation (240:672,1978) is a worthwhile contribution to the understanding of this condition. I would like to suggest that before a patient is subjected to pericardial surgery, an alternate approach be attempted, ie, pericardial catheterization. I have done this for many years with success.1-3 It is true, of course, that catheters can plug owing to protein-rich exudate, blood, and debris. However, I have had a draining catheter in the pericardium as long as eight days without this happening. It is also my routine to catheterize the pericardium whenever a pericardiocentesis is done so that even during a single-shot pericardial tap, the pericardium is drained by a relatively soft catheter rather than a sharp needle.3 With the catheter left in situ, patients are usually spared both repeated pericardiocentesis and ultimate surgery.
Spodick DH. Pericardial Drainage. JAMA. 1978;240(24):2633. doi:10.1001/jama.1978.03290240033017