Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report.

Abstract

A 79-year-old lean man with a height of 157cm and weight of 42kg (body mass index, 17.2kg/m(2)) receiving rivaroxaban developed an intracranial subdural hematoma and was treated conservatively. Because he had a reduced creatinine clearance of 44mL/min, his dosage of rivaroxaban was reduced from 15 to 10mg daily according to official Japanese prescribing information. However, he developed bilateral intracranial subdural hematomas 2weeks later. Plasma rivaroxaban concentration on anti-factor Xa chromogenic assay was elevated at 301ng/mL, suggesting excessive accumulation. He underwent burr hole drainage and resumed anticoagulation with warfarin. Subsequently, he developed a lumbosacral hematoma. He was treated conservatively and discharged without neurological sequelae. The main cause of the increased concentration of rivaroxaban was believed to be his older age and low body weight. The etiology of the spinal hematoma was suspected to be the migration of intracranial hematoma to the spinal subdural space.

• Authors: Yoshitaka Yamaguchi, Masatoshi Koga, Takayuki Matsuki, Tenyu Hino, Chiaki Yokota, Kazunori Toyoda
• Journal: Thrombosis research (Thromb Res) Vol. 143 Pg. 127-9 (Jul 2016) ISSN: 1879-2472 [Electronic] United States
• PMID: 27240110 (Publication Type: Case Reports, Letter)
• Copyright: Copyright © 2016 Elsevier Ltd. All rights reserved.

Chemical References

• Anticoagulants
• Factor Xa Inhibitors
• Warfarin
• Rivaroxaban

Topics

• Aged
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Drainage
• Factor Xa Inhibitors (adverse effects, blood, therapeutic use)
• Hematoma, Subdural, Intracranial (chemically induced, pathology)
• Hematoma, Subdural, Spinal (chemically induced, pathology)
• Humans
• Male
• Rivaroxaban (adverse effects, blood, therapeutic use)
• Warfarin (therapeutic use)