rivaroxaban and Neck-Pain

Topics: Aged; Factor Xa Inhibitors; Female; Headache; Hormone Replacement Therapy; Humans; Jugular Veins; Neck Pain; Pacemaker, Artificial; Phlebography; Rivaroxaban; Tomography, X-Ray Computed; Ultrasonography, Doppler; Venous Thrombosis

The authors report a case of a 69-year-old woman who presented with a spontaneous spinal epidural hematoma (SSEH) 10 days after a total hip arthroplasty. The patient had been receiving 10 mg/d of rivaroxaban for 5 days for venous thromboembolism prophylaxis. She had a sudden onset of severe neck pain, followed by quadriplegia below C4. A dorsal SSEH was revealed by computed tomography. While preparing for the emergency evacuation of the SSEH, the neurological symptoms resolved spontaneously in 4 hours. The 1-month follow-up magnetic resonance imaging confirmed that the SSEH had completely resolved. The pathogenesis of SSEH is unclear, but anticoagulant therapy is a known risk factor. It is a relatively rare disorder. Only 1 case of SSEH has been reported, and that patient was receiving a nonsteroidal anti-inflammatory drug besides rivaroxaban, which is another known risk factor for bleeding disorders. [Orthopedics. 2016; 39(3):e558-e560.].

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Female; Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Neck Pain; Rare Diseases; Risk Factors; Rivaroxaban; Tomography, X-Ray Computed; Venous Thromboembolism