Hemothorax after Central Venous Catheter Insertion in Patient with Triple Antithrombotic Therapy: A Case Report

Some mild-to-severe complications can occur following central venous catheter (CVC) insertion. Hemothorax is a rare complication. Controlling the bleeding is key to managing this condition. The use of triple antithrombotic therapy may become a challenge in controlling the bleeding. We report the case of a patient with hemothorax following CVC placement at the right subclavian vein. The patient was on triple antithrombotic therapy (aspirin, ticagrelor, and warfarin) following primary percutaneous coronary intervention procedure as he presented with ST-segment elevation myocardial infarction and new-onset atrial fibrillation during hospitalization. After CVC insertion, a chest X-ray confirmed a hemothorax that filled up to half of the right hemithorax. A thorax drain was then inserted with an initial blood drain of 140cc. Ticagrelor, as one of the dual antiplatelet therapies, was switched to clopidogrel, and warfarin as anticoagulant thromboembolic prophylactic at atrial fibrillation was stopped. Thorax drain was pulled out on day 8 of admission with a total production of 460cc blood with good clinical signs. Chest X-ray evaluation revealed a clear lung without residual hemothorax. Thorax drain insertion and triple antithrombotic therapy adjustment successfully managed this bleeding complication. Hemothorax, as one of the bleeding complications secondary to CVC insertion, could be associated with significant morbidity and mortality, especially in patients with triple antithrombotic therapy. Prompt treatment is mandatory to save a patient's life, including immediate identification and treatment such as thorax drain insertion and triple antithrombotic adjustment.