title: Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivaroxaban): a challenging management.
abstract: We 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.
  
  
  
  The 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.
  
  
  
  Determining 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.
authors.affiliation: Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Dargazanli
authors.affiliation: Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lonjon
authors.affiliation: Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France. guillaumegrascombe@yahoo.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gras-Combe
mesh_terms: D000368:Aged; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D046649:Hematoma, Subdural, Spinal / Q000139:chemically induced*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010264:Paraplegia / Q000209:etiology; D000069552:Rivaroxaban / Q000627:therapeutic use*; D013118:Spinal Cord Diseases / Q000139:chemically induced*
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
keywords: Factor Xa inhibitor; Rivaroxaban; Spinal cord; Spinal subdural hematoma; Spine surgery