Retroperitoneal haematoma in a postoperative ALIF patient taking rivaroxaban for atrial fibrillation
Background Novel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients...
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Published in | European spine journal Vol. 28; no. 4; pp. 688 - 692 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.04.2019
Springer Nature B.V |
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Abstract | Background
Novel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients.
Case report
We report a case of a rivaroxaban-induced retroperitoneal haematoma in a 72-year-old man who underwent an L5/S1 anterior lumbar interbody fusion (ALIF) for grade 1 spondylolytic spondylolisthesis. The patient suffered from atrial fibrillation and was taking rivaroxaban, a factor Xa inhibitor, for thromboembolic risk reduction. In accordance with perioperative Novel Oral Anticoagulant (NOAC) guidelines, rivaroxaban was stopped 2 days preoperatively and restarted on the third postoperative day. The patient presented on the ninth postoperative day, complaining of severe left iliac fossa pain, nausea, and vomiting, accompanied by swelling and bruising around the surgical site. A computed tomography (CT) scan showed a large expanding retroperitoneal haematoma. The patient was taken back to theatre for an evacuation of the haematoma and subsequently recovered without any further complications.
Conclusion
This is the first case of a rivaroxaban-induced retroperitoneal haematoma reported in the literature, secondary to elective spinal surgery. This report adds to the body of evidence on the risk of postoperative bleeding in patients taking NOACs. If patients on NOACs present with abdominal symptoms following anterior approach to the lumbar spine, treating clinicians should have a high index of suspicion for retroperitoneal haematoma. |
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AbstractList | Novel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients.
We report a case of a rivaroxaban-induced retroperitoneal haematoma in a 72-year-old man who underwent an L5/S1 anterior lumbar interbody fusion (ALIF) for grade 1 spondylolytic spondylolisthesis. The patient suffered from atrial fibrillation and was taking rivaroxaban, a factor Xa inhibitor, for thromboembolic risk reduction. In accordance with perioperative Novel Oral Anticoagulant (NOAC) guidelines, rivaroxaban was stopped 2 days preoperatively and restarted on the third postoperative day. The patient presented on the ninth postoperative day, complaining of severe left iliac fossa pain, nausea, and vomiting, accompanied by swelling and bruising around the surgical site. A computed tomography (CT) scan showed a large expanding retroperitoneal haematoma. The patient was taken back to theatre for an evacuation of the haematoma and subsequently recovered without any further complications.
This is the first case of a rivaroxaban-induced retroperitoneal haematoma reported in the literature, secondary to elective spinal surgery. This report adds to the body of evidence on the risk of postoperative bleeding in patients taking NOACs. If patients on NOACs present with abdominal symptoms following anterior approach to the lumbar spine, treating clinicians should have a high index of suspicion for retroperitoneal haematoma. Abstract[InlineMediaObject not available: see fulltext.]BackgroundNovel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients.Case reportWe report a case of a rivaroxaban-induced retroperitoneal haematoma in a 72-year-old man who underwent an L5/S1 anterior lumbar interbody fusion (ALIF) for grade 1 spondylolytic spondylolisthesis. The patient suffered from atrial fibrillation and was taking rivaroxaban, a factor Xa inhibitor, for thromboembolic risk reduction. In accordance with perioperative Novel Oral Anticoagulant (NOAC) guidelines, rivaroxaban was stopped 2 days preoperatively and restarted on the third postoperative day. The patient presented on the ninth postoperative day, complaining of severe left iliac fossa pain, nausea, and vomiting, accompanied by swelling and bruising around the surgical site. A computed tomography (CT) scan showed a large expanding retroperitoneal haematoma. The patient was taken back to theatre for an evacuation of the haematoma and subsequently recovered without any further complications.ConclusionThis is the first case of a rivaroxaban-induced retroperitoneal haematoma reported in the literature, secondary to elective spinal surgery. This report adds to the body of evidence on the risk of postoperative bleeding in patients taking NOACs. If patients on NOACs present with abdominal symptoms following anterior approach to the lumbar spine, treating clinicians should have a high index of suspicion for retroperitoneal haematoma. Background Novel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients. Case report We report a case of a rivaroxaban-induced retroperitoneal haematoma in a 72-year-old man who underwent an L5/S1 anterior lumbar interbody fusion (ALIF) for grade 1 spondylolytic spondylolisthesis. The patient suffered from atrial fibrillation and was taking rivaroxaban, a factor Xa inhibitor, for thromboembolic risk reduction. In accordance with perioperative Novel Oral Anticoagulant (NOAC) guidelines, rivaroxaban was stopped 2 days preoperatively and restarted on the third postoperative day. The patient presented on the ninth postoperative day, complaining of severe left iliac fossa pain, nausea, and vomiting, accompanied by swelling and bruising around the surgical site. A computed tomography (CT) scan showed a large expanding retroperitoneal haematoma. The patient was taken back to theatre for an evacuation of the haematoma and subsequently recovered without any further complications. Conclusion This is the first case of a rivaroxaban-induced retroperitoneal haematoma reported in the literature, secondary to elective spinal surgery. This report adds to the body of evidence on the risk of postoperative bleeding in patients taking NOACs. If patients on NOACs present with abdominal symptoms following anterior approach to the lumbar spine, treating clinicians should have a high index of suspicion for retroperitoneal haematoma. BACKGROUNDNovel oral anticoagulants (NOACs) are being increasingly used in the secondary prevention of thromboembolic stroke in patients with atrial fibrillation. Patients taking NOACs are difficult to manage perioperatively, and several unexpected complications have been reported in these patients. CASE REPORTWe report a case of a rivaroxaban-induced retroperitoneal haematoma in a 72-year-old man who underwent an L5/S1 anterior lumbar interbody fusion (ALIF) for grade 1 spondylolytic spondylolisthesis. The patient suffered from atrial fibrillation and was taking rivaroxaban, a factor Xa inhibitor, for thromboembolic risk reduction. In accordance with perioperative Novel Oral Anticoagulant (NOAC) guidelines, rivaroxaban was stopped 2 days preoperatively and restarted on the third postoperative day. The patient presented on the ninth postoperative day, complaining of severe left iliac fossa pain, nausea, and vomiting, accompanied by swelling and bruising around the surgical site. A computed tomography (CT) scan showed a large expanding retroperitoneal haematoma. The patient was taken back to theatre for an evacuation of the haematoma and subsequently recovered without any further complications. CONCLUSIONThis is the first case of a rivaroxaban-induced retroperitoneal haematoma reported in the literature, secondary to elective spinal surgery. This report adds to the body of evidence on the risk of postoperative bleeding in patients taking NOACs. If patients on NOACs present with abdominal symptoms following anterior approach to the lumbar spine, treating clinicians should have a high index of suspicion for retroperitoneal haematoma. |
Author | Chan, Daniel Deekonda, Praveena Stokes, Oliver M. |
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References | ZaarourMHassanSThumallapallyNDaiQRivaroxaban-induced nontraumatic spinal subdural hematoma: an uncommon yet life-threatening complicationCase Rep Hematol201510.1155/2015/275380265436544620391 Lip GYH, Douketis JD (2016) Perioperative management of patients receiving anticoagulants. In: UpToDate. http://www.uptodate.com/contents/perioperative-management-of-patients-receiving-anticoagulants. Accessed 28 Apr 2016 Novel oral anticoagulants (NOACs) in atrial fibrillation. http://northeast.devonformularyguidance.nhs.uk/formulary/chapters/2.-cardiovascular/novel-oral-anticoagulants-noacs-in-atrial-fibrillation. Accessed 15 Nov 2015 SalemisNSOikonomakisILagoudianakisEEnoxaparin-induced spontaneous massive retroperitoneal hematoma with fatal outcomeAm J Emerg Med2014321559e1e3 ThalerMMayrELiebensteinerMBachCMInjury of the right and left inferior epigastric artery during the implantation of a stand-alone ALIF cage through a left retroperitoneal approach: a case reportArch Orthop Trauma Surg2010130313510.1007/s00402-009-0848-219280206 Xarelto 20 mg film-coated tablets–Summary of Product Characteristics (SPC)–(eMC). https://www.medicines.org.uk/emc/medicine/25586. Accessed 15 Nov 2015 MobbsRJPhanKDalyDApproach-related complications of anterior lumbar interbody fusion: results of a combined spine and vascular surgical teamGlobal Spine J2016614715410.1055/s-0035-155714126933616 Perioperative management of patients receiving anticoagulants. http://www.uptodate.com/contents/perioperative-management-of-patients-receiving-anticoagulants?source=search_result&search=Perioperative+management+of+patients+receiving+anticoagulants&selectedTitle=1%7E150#H753198. Accessed 15 Nov 2015 SungaKLBellolioMFGilmoreRMCabreraDSpontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcomeJ Emerg Med201243e157e16110.1016/j.jemermed.2011.06.00621911282 4822_CR3 4822_CR2 KL Sunga (4822_CR6) 2012; 43 4822_CR9 NS Salemis (4822_CR7) 2014; 32 RJ Mobbs (4822_CR5) 2016; 6 M Zaarour (4822_CR8) 2015 4822_CR1 M Thaler (4822_CR4) 2010; 130 |
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SubjectTerms | Anticoagulants Cardiac arrhythmia Case reports Computed tomography Fibrillation Grand Rounds Hematoma Medicine Medicine & Public Health Nausea Neurosurgery Pain Patients Spine (lumbar) Spondylolisthesis Surgery Surgical Orthopedics Thromboembolism Vomiting |
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Title | Retroperitoneal haematoma in a postoperative ALIF patient taking rivaroxaban for atrial fibrillation |
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