warfarin and Hematoma--Subdural--Spinal

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.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Drainage; Factor Xa Inhibitors; Hematoma, Subdural, Intracranial; Hematoma, Subdural, Spinal; Humans; Male; Rivaroxaban; Warfarin

We report a rare case of simultaneous cranial subarachnoid and spinal subdural hematoma (SDH) in a 42-year-old man who was on Warfarin therapy after cardiac bypass surgery. Computed tomography at presentation revealed a cranial subarachnoid hemorrhage, and spinal Magnetic Resonance Imaging (MRI) showed a spinal SDH extending from the T6 to L5 segments. He had paraparesis due to spinal cord compression. The patient was managed conservatively due to his poor general condition and was infused with intravenous steroid therapy, but he experienced sudden cardiac arrest 5 hours later after being admitted to the hospital. This case is of interest because of its first presentation of spinal subdural hematoma and cranial subarachnoid hemorrhage simultaneously and it is also the second longest vertebral segmental spread in the literature.

Topics: Adult; Anticoagulants; Coronary Artery Bypass; Death, Sudden, Cardiac; Fatal Outcome; Hematoma, Subdural, Spinal; Humans; Magnetic Resonance Imaging; Male; Spinal Cord Compression; Subarachnoid Hemorrhage; Warfarin

We are presenting a case of non-traumatic spontaneous spinal subdural hematoma in a patient on warfarin and fluoxetine. This diagnosis should be considered early in patients who are on warfarin or fluoxetine or both presenting with acute neurological abnormalities of the limbs, and early decompression could result in good neurological outcome.

Topics: Aged; Antifibrinolytic Agents; Back Pain; Blood Coagulation Factors; Combined Modality Therapy; Decompression, Surgical; Dexamethasone; Early Diagnosis; Early Medical Intervention; Fluoxetine; Glucocorticoids; Hematoma, Subdural, Spinal; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Paraplegia; Spinal Cord Compression; Treatment Outcome; Urinary Retention; Vitamin K; Warfarin