Abstract
In the last decade, the desire for safer oral anticoagulants (OACs) led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH). Our case is the third one described and the first one to involve the cervicothoracic spine.
Highlights
Warfarin, a vitamin K antagonist (VKA), was the only available oral anticoagulant (OAC)
In addition to noninferiority compared to warfarin in selected clinical scenarios, rivaroxaban has the advantage of once daily dosing, faster onset of action, larger therapeutic index obviating the need for close monitoring, and lower risk of bleeding [2, 3]
We found only two cases of nontraumatic spinal hematoma associated with dabigatran therapy [15, 16]
Summary
Warfarin, a vitamin K antagonist (VKA), was the only available oral anticoagulant (OAC). The need for new OACs emerged, as warfarin has multiple food and drug interactions and requires frequent monitoring [1]. In addition to noninferiority compared to warfarin in selected clinical scenarios, rivaroxaban has the advantage of once daily dosing, faster onset of action, larger therapeutic index obviating the need for close monitoring, and lower risk of bleeding [2, 3]. Intracranial hemorrhage (ICH) is one of the most common bleeding complications associated with OACs. Traumatic spinal hematoma is a well-known complication following the administration of these agents. Only two cases in the literature describe nontraumatic spinal subdural hematoma (SSDH) in the setting of rivaroxaban therapy (Table 1). Informed consent was obtained from the patient prior to publication
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