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

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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.

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Author information

Authors and Affiliations

  1. Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France

    Cyril Dargazanli

  2. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France

    Nicolas Lonjon & Guillaume Gras-Combe

Authors
  1. Cyril Dargazanli
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  2. Nicolas Lonjon
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  3. Guillaume Gras-Combe
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Corresponding author

Correspondence to Guillaume Gras-Combe.

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None of the authors has any potential conflict of interest.

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Dargazanli, C., Lonjon, N. & Gras-Combe, G. Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivaroxaban): a challenging management. Eur Spine J 25 (Suppl 1), 100–103 (2016). https://doi.org/10.1007/s00586-015-4160-2

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  • DOI: https://doi.org/10.1007/s00586-015-4160-2

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