Spontaneous thoracic spinal subdural hematoma associated with apixaban therapy

Abstract

Spontaneous spinal subdural hematomas are extremely rare. Most spinal hematomas are discovered in the epidural space. In the majority of cases, spontaneous hematomas are idiopathic. However, when attributed to anticoagulation therapy coumarins are more common than direct factor Xa inhibitors such as apixaban. Previous reports have linked direct factor Xa inhibitors with intracranial subdural hematomas much more frequently than spinal subdural hematomas. The manifestation of severe neurological deficits, such as sensorimotor disturbances and loss of sphincter control, is common and is considered a surgical emergency. The present case consists of a patient with a spontaneous spinal thoracic subdural hematoma secondary to apixaban use with loss of sphincter control and paraplegia. After 6 months of follow-up, the patient recovered completely.

A Rare Case of Apixaban-Induced Subdural Hematoma in Elderly Heart Failure Patient

“…10 Another case report by reported a spontaneous thoracic spinal subdural hematoma associated with apixaban therapy. 11 These cases highlight the importance of considering subdural hematoma as a potential complication in patients receiving apixaban therapy.…”

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

“…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.…”

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

“…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].…”

“…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].…”