• Thrombosis research · Jul 2016

    Letter Case Reports

    Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report.

    • Yoshitaka Yamaguchi, Masatoshi Koga, Takayuki Matsuki, Tenyu Hino, Chiaki Yokota, and Kazunori Toyoda.
    • Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: yyamaguchi@ncvc.co.jp.
    • Thromb. Res. 2016 Jul 1; 143: 127-9.

    AbstractA 79-year-old lean man with a height of 157cm and weight of 42kg (body mass index, 17.2kg/m(2)) receiving rivaroxaban developed an intracranial subdural hematoma and was treated conservatively. Because he had a reduced creatinine clearance of 44mL/min, his dosage of rivaroxaban was reduced from 15 to 10mg daily according to official Japanese prescribing information. However, he developed bilateral intracranial subdural hematomas 2weeks later. Plasma rivaroxaban concentration on anti-factor Xa chromogenic assay was elevated at 301ng/mL, suggesting excessive accumulation. He underwent burr hole drainage and resumed anticoagulation with warfarin. Subsequently, he developed a lumbosacral hematoma. He was treated conservatively and discharged without neurological sequelae. The main cause of the increased concentration of rivaroxaban was believed to be his older age and low body weight. The etiology of the spinal hematoma was suspected to be the migration of intracranial hematoma to the spinal subdural space. Copyright © 2016 Elsevier Ltd. All rights reserved.

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