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

• Published in: European spine journal Vol. 25; no. Suppl 1; pp. 100 - 103
• Main Authors: Dargazanli, Cyril, Lonjon, Nicolas, Gras-Combe, Guillaume
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2016; Springer Nature B.V; Springer Verlag
• Subjects: Aged; Case Report; Factor Xa Inhibitors - therapeutic use; Hematoma, Subdural, Spinal - chemically induced; Human health and pathology; Humans; Life Sciences; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neurons and Cognition; Neurosurgery; Paraplegia - etiology; Rivaroxaban - therapeutic use; Spinal Cord Diseases - chemically induced; Surgical Orthopedics; Rivaroxaban; Spinal cord; Spinal subdural hematoma; Spine surgery; Factor Xa inhibitor
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-015-4160-2

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.