Spontaneous spinal epidural haematoma during Factor Xa inhibitor treatment (Rivaroxaban)

Abstract

We report on a 61-year-old female patient who developed a spontaneous spinal epidural haematoma (SSEH) after being treated by rivaroxaban, a new agent for the prevention of venous thromboembolic events in orthopaedic surgery. Although the pathogenesis of SSEH is unclear, anticoagulant therapy is a known risk factor. The patient sustained a sudden onset of severe back pain in the thoracic spine, followed by paraplegia below T8, 2 days after proximal tibial osteotomy and rivaroxaban therapy. Magnetic resonance imaging (MRI) of the whole spine demonstrated a ventral SSEH from C2 to T8. Whilst preparing for the emergency evacuation of the SSEH, the neurological symptoms recovered spontaneously 4 h after onset without surgery. After monitored bed rest for 48 h the MRI was repeated and the SSEH was no longer present. This rare condition of spinal cord compression and unusually rapid spontaneous recovery has not previously been reported following rivaroxaban therapy.

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…However, no details regarding risk factors or frequency are reported. A review of the literature noted 7 neuraxial hematomas associated with rivaroxaban [125][126][127][128][129][130][131][132][133][134] (Table 10). Three of the patients had undergone a neuraxial block.…”

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

“…A few cases of spinal hematoma directly related to anticoagulant treatment have been reported, most of them presenting as epidural hematomas [11]. Only three cases of spontaneous spinal subdural hematoma associated with the use of rivaroxaban have been reported in the literature [2–4], but to our knowledge, no case due to apixaban has been described.…”

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

“…Because of uncertainties in the etiology of these SEHs, they could be chronic hemorrhagic synovial cysts, and they were not included in our series. With regard to the first reports of SEH during treatment with oral anticoagulants, such as factor Xa inhibitors, 35,48 there are uncertainties regarding the alteration in hematological indices and, therefore, these cases cannot be included among those associated with coagulopathy.…”