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Pericardial Effusion: Pharmacologic Recommendations

Initial

Size of Effusion

Follow-up 

Size of Effusion

Initial Management

Continuing Management

Small Resolved NSAID
  • Discontinue NSAID
  • Wean diuretic
Small Unchanged NSAID
  • Continue NSAID
  • Add steroid
  • Assess need for GI prophylaxis
  • Continue diuretic
Small Moderate NSAID
  • Continue NSAID
  • Add steroid
  • Assess need for GI prophylaxis
  • Continue diuretic
Moderate Small NSAID + steroid
  • Consider discontinuing NSAID and steroid
  • Continue diuretic
Moderate Unchanged NSAID + steroid
  • Continue NSAID + steroid
  • Consider adding colchicine
    • If starting colchicine, may consider stopping NSAIDs
  • Continue diuretic
Small/Moderate Large NSAID +/-steroid
  • Admit
Large - -
  • Admit

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.