• Eur Spine J · May 2016

    Case Reports

    Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivaroxaban): a challenging management.

    • Cyril Dargazanli, Nicolas Lonjon, and Guillaume Gras-Combe.
    • Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France.
    • Eur Spine J. 2016 May 1; 25 Suppl 1: 100-3.

    PurposeWe report on a 72-year-old male patient who developed a nontraumatic spinal subdural hematoma (SSDH) during rivaroxaban therapy, a relatively new orally administered direct factor Xa inhibitor.Case DescriptionThe patient sustained a sudden onset of interscapular pain, followed by gait impairment and paraplegia. Magnetic resonance imaging (MRI) of the spine demonstrated SSDH from T6 to T8. Laboratory tests revealed a high rivaroxaban level, associated with a major hemorrhagic risk. Surgery was, therefore, performed the following morning, after normalization of coagulation parameters.ConclusionDetermining the time of safe surgery remains challenging when hemorrhagic complications happen with direct factor Xa inhibitor, especially when neurological prognosis is engaged. Spinal subdural hematoma has not previously been reported following rivaroxaban therapy.

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