Iatrogenic Spinal Subdural Hematoma due to Apixaban: A Case Report and Review of the Literature

Colell, Alba; Arboix, Adrià; Caiazzo, Francesco; Grivé, Elisenda

doi:10.1155/2018/4507638

Cited by 7 publications

(14 citation statements)

References 16 publications

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“…ere was no associated bleeding with either surgical intervention. On the other hand, 5 cases (including this report) had delayed surgical intervention (>24 hours) [5][6][7][8][9]. Among these cases, only 2 had good recovery (40%), and 3 had bad outcomes.…”

Section: Discussionmentioning

confidence: 80%

“…Since the first description of a case of SH associated with the use of a DOAC (rivaroxaban) in 2012 [1], there have been a total of 10 other reports describing both SSEH and spinal subdural hematomas (SSDHs) in association with different DOACs [2][3][4][5][6][7][8][9]. As the use of DOACs continues to increase [10], more similar cases are expected to complicate treatment with these agents.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Alayli

Neelakandan

Krayem

2020

Case Reports in Hematology

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Background. With the rise in the use of direct oral anticoagulants (DOACs), more hemorrhagic complications are being encountered. Since the first description of a case of spontaneous spinal epidural hematoma (SSEH) related to the utilization of DOACs in 2012, there have been few reports describing a similar association. However, no cases so far have reported an association between SSEHs and apixaban. Case Description: A 76-year-old lady, with a history of nonvalvular atrial fibrillation, presented with a new onset of progressive left lower and upper extremity weakness. She reported back pain and numbness in the left leg up to the knee along with numbness in the left arm up to the shoulder. A CT scan of the neck was suggestive of an epidural hematoma extending from C2-C3 level to C6-C7. As the patient was on apixaban at the time, surgical treatment was delayed for two days to decrease the risk of intraoperative bleeding. Nine days later, she was discharged. Her physical exam was almost unchanged from that on presentation, except for resolution of pain and minimal improvement in motor power in her left lower extremity from 1/5 to 2/5 distally. Conclusions. Spinal hematomas represent surgical emergencies with earlier intervention portending better outcome. Based on the few case reports that point to DOACs as a potential culprit, it appears that a high suspicion index resulting in earlier SSEH diagnosis and intervention is crucial for improved neurological outcome and recovery. Prompt diagnosis remains a challenge, especially that SSEH can mimic cerebrovascular accidents.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Alayli

Neelakandan

Krayem

2020

Case Reports in Hematology

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“…NOACs are increasingly used as alternatives to warfarin, as the latter has many potential limitations and side effects, including food drug interactions, delayed onset of action, narrow therapeutic window, and the need to close monitoring of the international normalized ratio plus a number of associated hemorrhagic adverse events. Apixaban is a direct factor Xa inhibitor and one of the new oral anticoagulants that has been shown to be effective in the reduction of stroke and embolic events in patients with nonvalvular atrial fibrillation [2]. A significant adverse effect of the drug is intracranial hemorrhage and traumatic spinal hematoma, although less common when compared with warfarin, especially in patients undergoing neuroanesthesia or spinal puncture [4].…”

Section: Discussionmentioning

confidence: 99%

“…Better outcomes can be expected with early neurological evaluation and intervention [8]. Conservative management might be considered in cases with mild neurological deficits, rapid spontaneous recovery, or high-risk surgical candidates [1,2,7].…”

Section: Discussionmentioning

confidence: 99%

“…Spinal subdural hematoma (SSDH) is a very rare neurological emergency that accounts for 4.1% of all intraspinal hematomas [1]. The exact etiology is still controversial with the hypothesized mechanism of a sudden increase of pressure in thoracic and/or abdominal cavities raising the pressure inside the subdural vessels with a subsequent rupture and formation of a hematoma [2]. Risk factors include arteriovenous malformations, coagulopathy, therapeutic anticoagulation, underlying neoplasms, or following a spinal puncture.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case Presentation of Apixaban-induced Nontraumatic Spinal Subdural Hematoma

Faiek

Wazzan

Sompalli

et al. 2020

Cureus

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A spinal subdural hematoma is a rare clinical entity and an uncommon urgent complication that can be associated with the use of vitamin K and less commonly nonvitamin K oral anticoagulants. It is considered a neurological emergency requiring prompt diagnosis and surgical intervention in the majority of the cases. Herein, we present an 84-year-old male patient with a history of nonvalvular atrial fibrillation on apixaban who presented with complaints of bilateral lower extremity weakness, severe back pain, and urinary retention. His lumbar and thoracic spine images showed a diffuse spinal subdural hematoma. Urgent neurosurgical intervention was performed with minimal improvement in his symptoms postoperatively. We report a case of spontaneous spinal subdural hematoma related to apixaban use with relevant literature review.

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Spontaneous spinal subdural haematoma in a patient on apixaban

2019

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A 68-year-old man on apixaban presented to the emergency department with back pain following a long-haul flight. Investigations for pulmonary embolus and aortic dissection were negative and he was discharged with analgesia for mechanical back pain. He presented three more times with worsening back pain, third time with urinary retention and the fourth time with lower limb weakness and loss of coordination. He was found to have a spinal subdural haematoma on MRI and transferred to a tertiary centre, where he was managed conservatively and discharged for rehabilitation with good neurological recovery.

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Iatrogenic Spinal Subdural Hematoma due to Apixaban: A Case Report and Review of the Literature

Cited by 7 publications

References 16 publications

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

A Rare Case Presentation of Apixaban-induced Nontraumatic Spinal Subdural Hematoma

Spontaneous spinal subdural haematoma in a patient on apixaban

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