Spontaneous Anterior Neck Hematoma Associated With Rivaroxaban Leading to Primary Hyperparathyroidism and Hypercalcemia

Abstract

New anticoagulation agents are now widely used for many indications. Post-marketing surveillance is intended to discover rare medication events that did not occur in clinical trials. The literature cites few reported cases of spontaneous neck hemorrhage while on anticoagulation. We report a case of an 86-year-old female with chronic atrial fibrillation who presented with spontaneous neck hematoma in the area of the parathyroid glands resulting in hyperparathyroidism and hypercalcemia while taking rivaroxaban. The hematoma spanned the anterior aspects of the neck and was confirmed via CT. The patient's anticoagulation therapy was discontinued and required intubation for airway protection. The parathyroid hormone (PTH) peaked to 176 mg/dL (upper limit of normal 65 pg/mL) followed by close to normalization of PTH and corrected calcium after appropriate treatment and stabilization of the hematoma, which did not require surgical evacuation.