title: Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report.
abstract: A 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.
authors.affiliation: Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: yyamaguchi@ncvc.co.jp.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.affiliation: Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsuki
authors.affiliation: Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Tenyu
authors.initials: T
authors.lastname: Hino
authors.affiliation: Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Yokota
authors.affiliation: Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D004322:Drainage; D065427:Factor Xa Inhibitors / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D046648:Hematoma, Subdural, Intracranial / Q000139:chemically induced* / Q000473:pathology; D046649:Hematoma, Subdural, Spinal / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008297:Male; D000069552:Rivaroxaban / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Anticoagulants; Atrial fibrillation; Intracranial subdural hematoma; Rivaroxaban; Spinal subdural hematoma