Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivaroxaban): a challenging management.

Abstract

PURPOSE:

We report on a 72-year-old male patient who developed a nontraumatic spinal subdural hematoma (SSDH) during rivaroxaban therapy, a relatively new orally administered direct factor Xa inhibitor.

CASE DESCRIPTION:

The patient sustained a sudden onset of interscapular pain, followed by gait impairment and paraplegia. Magnetic resonance imaging (MRI) of the spine demonstrated SSDH from T6 to T8. Laboratory tests revealed a high rivaroxaban level, associated with a major hemorrhagic risk. Surgery was, therefore, performed the following morning, after normalization of coagulation parameters.

CONCLUSION:

Determining the time of safe surgery remains challenging when hemorrhagic complications happen with direct factor Xa inhibitor, especially when neurological prognosis is engaged. Spinal subdural hematoma has not previously been reported following rivaroxaban therapy.

• Authors: Cyril Dargazanli, Nicolas Lonjon, Guillaume Gras-Combe
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 25 Suppl 1 Pg. 100-3 (05 2016) ISSN: 1432-0932 [Electronic] Germany
• PMID: 26228186 (Publication Type: Case Reports, Journal Article)

Chemical References

• Factor Xa Inhibitors
• Rivaroxaban

Topics

• Aged
• Factor Xa Inhibitors (therapeutic use)
• Hematoma, Subdural, Spinal (chemically induced)
• Humans
• Magnetic Resonance Imaging
• Male
• Paraplegia (etiology)
• Rivaroxaban (therapeutic use)
• Spinal Cord Diseases (chemically induced)