Spinal Cord Compression Secondary to a Spontaneous Spinal Haematoma in a Patient Newly Treated with Rivaroxaban
  • Javier Guerrero-Niño
    Service des Urgences, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  • Sara De Cesaris
    Service des Urgences, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  • Xavier Jannot
    Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  • Noel Lorenzo Villalba
    Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

Keywords

Rivaroxaban, major bleeding, complete flaccid paraplegia, anticoagulation

Abstract

A 74-year-old patient anticoagulated with rivaroxaban for chronic atrial fibrillation presented to the emergency department with acute lumbar pain with progressive weakness of the lower limbs and inability to stand up. No previous trauma was reported. Neurological examination was consistent with a complete spinal cord syndrome at the level of T6. Magnetic resonance imaging showed the presence of spinal cord compression associated with signs of extensive intramedullary inflammation secondary to a haematoma. The patient underwent thoracic laminectomy with evacuation of an intradural haematoma. No intraoperative complications were described, but no clinical improvement had been achieved 15 days after the surgical intervention.

VIEW THE ENTIRE ARTICLE

References

  • Testa S, Legnani C, Antonucci E, Paoletti O, Dellanoce C, Cosmi B, et al; Coordinator of START2-Register. Drug levels and bleeding complications in atrial fibrillation patients treated with direct oral anticoagulants. J Thromb Haemost 2019;17(7):1064–1072.
  • Schulman S, Kearon C; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005;3(4):692–694.
  • Beyer Westendorf J, Forster K, Pannach S, Ebertz F, Gelbricht V, Thieme C, et al. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood 2014;124:955–962.
  • Fiani B, Jarrah R, Fiani NJ, Runnels J. Spontaneous cervical epidural hematoma: insight into this occurrence with case examples. Surg Neurol Int 2021;12:79.
  • Nguyen SN, Ruegger MC, Salazar E, Dreucean D, Tatara AW, Donahue KR. Evaluation of anti-Xa apixaban and rivaroxaban levels with respect to known doses in relation to major bleeding events. J Pharm Pract 2021 Apr 12:8971900211009075.
  • Goodman SG, Wojdyla DM, Piccini JP, et al. Factors associated with major bleeding events: insights from the ROCKET AF trial (rivaroxaban once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation). J Am Coll Cardiol 2014;63(9):891–900.
  • Massicotte A. A practice tool for the new oral anticoagulants [published correction appears in Can Pharm J (Ott). 2014;147(5):319]. Can Pharm J (Ott) 2014;147(1):25–32.
  • Diener H-C, Aisenberg J, Ansell J, Atar D, Breithardt G, Eikelboom J, et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1. Eur Heart J 2017;38(12):852–859.
  • By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019;67(4):674–694.
  • Views: 967
    HTML downloads: 70
    PDF downloads: 346


    Published: 2021-05-10
    Issue: 2021: Vol 8 No 5 (view)


    How to cite:
    1.
    Guerrero-Niño J, De Cesaris S, Jannot X, Lorenzo Villalba N. Spinal Cord Compression Secondary to a Spontaneous Spinal Haematoma in a Patient Newly Treated with Rivaroxaban. EJCRIM 2021;8 doi:10.12890/2021_002593.

    Most read articles by the same author(s)

    1 2 > >>