Venous/arterial thrombosis and pulmonary thrombosis accounts for very rare side effects of prothrombin complex concentrate and should be taken into account while administration.

68-year-old male with history of stroke, atrial fibrillation on apixaban presented with shortness of breath and hypotension and found to have large, organized, circumferential pericardial effusion on bedside POCUS.

CT chest and transthoaracic echocardiogram confirmed large pericardial effusion along with clinical evidence of tamponade. Prothrombin complex concentrate was given in preparation for emergent pericardiocentesis.

Pericardiocentesis was done with the removal of 800 cc of bloody fluid from the pericardial space.

While placing central line in the ICU, jugular venous thrombosis was noticed on ultrasound.

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