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

• DOI: 10.1007/s00586-015-4160-2
• Publication Date: 2015-07-30T09:50:51Z
• Authors: Cyril Dargazanli; Nicolas Lonjon; Guillaume Gras-Combe
• Keywords: Male; Paraplegia; Spinal cord; Factor Xa inhibitor; Spinal subdural hematoma; Magnetic Resonance Imaging; Spinal Cord Diseases; 3. Good health; 03 medical and health sciences; Spine surgery; 0302 clinical medicine; Rivaroxaban; Hematoma, Subdural, Spinal; Humans; [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology; Aged; Factor Xa Inhibitors

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.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.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.