Spontaneous Cervical Spinal Epidural Hematoma Associated with Dabigatran

Mathais, Quentin; Esnault, Pierre; Cruc, Maximilien; Corvilain, Bernard; Prunet, Bertrand; Gaillard, P

doi:10.1016/j.wneu.2018.01.199

Cited by 12 publications

(17 citation statements)

References 10 publications

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“…MRI is the gold standard radiological investigation for patients presenting with signs and symptoms of spinal cord injury. The spontaneous cervical hematoma was of high intensity or heterogeneous in T1-weighted and low intensity in T2-weighted in most findings [4][5][6]. Different theories have supported that the internal epidural plexus is responsible for the bleed into the epidural space.…”

Section: Discussionmentioning

confidence: 96%

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Dokponou¹,

Belhachmi²,

Imoumby³

et al. 2021

World J. Adv. Res. Rev.

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Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

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Section: Discussionmentioning

confidence: 96%

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Dokponou¹,

Belhachmi²,

Imoumby³

et al. 2021

World J. Adv. Res. Rev.

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“…SSEH as a complication of anticoagulation treatment most often develops with the use of warfarin [20,21], especially in patients who have an INR of above 3 [13]. There have been reports of patients with SSEH on direct oral anticoagulants (DOAC) such as dabigatran [22,23], rivaroxaban [24,25] and apixaban [26], but much less than in warfarin. Similar observations of SSEH development in patients with warfarin, dabigatran and rivaroxaban were found also in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Correction of the coagulation is improved by the administration of fresh frozen plasma, vitamin K or prothrombin complex concentrate. Idarucizumab, a specific antidote to dabigatran, has been successfully used in SSEH, resulting in a complete neurological recovery [23]. Adnexanet alpha is recommended to be used as an antidote for patients taking apixaban or rivaroxaban [39].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant / antiplatelet treatment

̌Sťetkářová

Ehler

Brabec

et al. 2021

Neurol Neurochir Pol.

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Aim of the study. Spontaneous spinal epidural haematomas (SSEH) are rare nosological units wherein acute collections of blood develop in the spinal canal. SSEH are usually manifested by sudden severe back pain accompanied by the development of neurological symptoms. In this study, we retrospectively describe management and the main risk factors of SSEH in a series of 14 cases. Material and methods.Between 2010 and 2019, we examined 14 patients (age range 17-89 years, 10 women) diagnosed with SSEH. Eight cases were patients using anticoagulant therapies (six warfarin, one dabigatran, one apixaban) and two others were using ASA of 100 mg/day. The exact localisation and extent of changes was determined from acute magnetic resonance imaging. Three people using warfarin had INR values higher than 3.0 at the time of their diagnosis. Results.Ten patients (71%) were taking oral anticoagulants or antiplatelet agents. In seven patients, SSEH were localised in the lower cervical/thoracic spine. Ten patients (71%) had arterial hypertension. Six patients underwent acute surgery due to rapidly developing spinal cord compression. Eight patients (57%) with slight or mild neurological symptoms were successfully managed without surgery.Conclusions. SSEH should be suspected in any patient receiving anticoagulant/antiplatelet agents who complains of sudden, severe back pain accompanied by neurological symptoms. SSEH is mostly localised in the lower cervical/thoracic spine. Arterial hypertension appears to be a risk factor of SSEH. Early decompression is an important therapeutic approach; in cases with minor neurological deficits, conservative treatment may be chosen.

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“…12 The occurrence of SSEH has been associated with several conditions, such as hemodialysis, thrombolysis, or antiplatelet-anticoagulant therapy including aspirin, dabigatran, and rivaroxaban. [13][14][15][16] MRI appears to be the gold standard imaging modality for diagnosis. Surgery and, more specifically, urgent decompressive laminectomy and evacuation of hematoma is indicated in several cases; however, it can occasionally be deferred if the patient demonstrates significant and rapid improvement.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient with STEMI—Two Medical Specialties Facing a Rare Dilemma

Tsarouchas

Mouselimis

Bakogiannis

et al. 2019

JNRP

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Spontaneous spinal epidural hematoma (SSEH) is a rare, albeit well-documented complication following thrombolysis treatment in ST elevation myocardial infarction (STEMI). A SSEH usually manifests with cervical pain and neurologic deficits and may require surgical intervention. In this case report, we present the first reported SSEH to occur following thrombolysis with reteplase. In this case, the SSEH manifested with cervical pain shortly after the patient emerged from his rescue percutaneous coronary intervention (PCI). Although magnetic resonance imaging reported spinal cord compression, the lack of neurologic symptoms prompted the treating clinicians to delay surgery. A dangerous dilemma emerged, as the usual antithrombotic regimen that was necessary to avoid stent thrombosis post-PCI, was also likely to exacerbate the bleeding. As a compromise, the patient only received aspirin as a single antiplatelet therapy. Ultimately, the patient responded well to conservative treatment, with the hematoma stabilizing a week later, without residual neurologic deficits. In conclusion, the conservative treatment of SSEH appears to be an acceptable option for carefully selected patients, but the risks of permanent neurologic deficits and stent thrombosis have to be weighted for each patient.

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Spontaneous Cervical Spinal Epidural Hematoma Associated with Dabigatran

Cited by 12 publications

References 10 publications

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant / antiplatelet treatment

Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient with STEMI—Two Medical Specialties Facing a Rare Dilemma

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