Spontaneous spinal epidural hematoma in a patient on oral anticoagulant (Dabigatran)
Medpusle International Journal of Medicine
Spontaneous spinal hematoma is a rare condition, which can lead to rapid and irreversible neurological impairment. The incidence in literature is reported to be one per 100,000 population per year and accounts for 0.3-0.9% of all spinal cord lesions. It can be secondary to an arterio-venous malformation, a cavernoma, a vertebral hemangioma, and frequently associated with provocative factors such as: anticoagulant or anti-aggregating drugs, minor trauma, peridural catheter insertion, severe
... or extreme effort such as delivery, etc. The new generation of nonvitamin K antagonist oral anticoagulants (NOACs) such as dabigatran, apixaban, and rivaroxaban has more predictable anticoagulant responses and has been shown to be effective in the prevention and treatment of venous thromboembolism. Nontraumatic spinal hematoma as a consequence of anticoagulant treatment is an exceptional complication. A few cases of nontraumatic spinal subdural hematoma related to treatment with NOACs have been reported in the literature, that too with use of rivaroxaban. We report a case of anticoagulant-induced spontaneous spinal hematoma that showed spontaneous rapid resolution of the spontaneous spinal hematoma on conservative management. This case report might help to raise awareness about high index of suspicion in establishing diagnosis & better idea about the optimal management in anticoagulant-induced spontaneous epidural hematoma of the spine in patient on nonvitamin K antagonist oral anticoagulants (NOACs).