Spontaneous Hematomyelia Associated with the Use of Non–vitamin K Antagonist

Abstract

Vitamin K antagonists have been frequently prescribed as anticoagulants with the potential side effect of spontaneous hematomyelia with a poor prognosis. However, to our knowledge, there has been no report of spontaneous hematomyelia combined with the use of a non–vitamin K antagonist. A 63-year-old man presented with left leg weakness, impaired sensation, and urinary retention while taking rivaroxaban (non–vitamin K antagonist) for 4 months for atrial fibrillation. Anticoagulant agents were discontinued. Methylprednisolone pulse therapy was administered without surgical hematoma evacuation. Three months after the initial development of the hematomyelia, the symptoms improved to grade 5 for both lower extremities, and there was complete recovery in sensory and urinary functions. This might be the first description of a complete recovery of neurologic deficits without hematoma evacuation in spontaneous hematomyelia patients caused by non–vitamin K antagonist therapy.

Keywords

anticoagulant - rivaroxaban - spinal intramedullary hematoma

Publikationsverlauf

Eingereicht: 25. April 2020

Angenommen: 26. November 2020

Artikel online veröffentlicht:
14. Juni 2021

• References

• 1 Papo I, Luongo A. Massive intramedullary hemorrhage in a patient on anticoagulants. Case report. J Neurosurg Sci 1974; 18 (04) 268-270
• 2 Brandt M. Spontaneous intramedullary haematoma as a complication of anticoagulant therapy. Acta Neurochir (Wien) 1980; 52 (1–2): 73-77
• 3 Constantini S, Ashkenazi E, Shoshan Y, Israel Z, Umansky F. Thoracic hematomyelia secondary to coumadin anticoagulant therapy: a case report. Eur Neurol 1992; 32 (02) 109-111
• 4 Cakirer S, Basak M, Galip GM. Cervical hematomyelia secondary to oral anticoagulant therapy: case report. Neuroradiology 2001; 43 (12) 1087-1088
• 5 Friedland ML, Wittels EG. Spinal cord haemorrhage following herpes zoster: a possible complication of warfarin therapy. Postgrad Med J 1982; 58 (675) 39-40
• 6 Pisani R, Carta F, Guiducci G, Silvestro C, Davini MD. Hematomyelia during anticoagulant therapy. Surg Neurol 1985; 24 (05) 578-580
• 7 Pullarkat VA, Kalapura T, Pincus M, Baskharoun R. Intraspinal hemorrhage complicating oral anticoagulant therapy: an unusual case of cervical hematomyelia and a review of the literature. Arch Intern Med 2000; 160 (02) 237-240
• 8 Famularo G, Sajeva MR, Gasbarrone L. Warfarin-associated hematomyelia. Intern Med 2014; 53 (06) 623-626
• 9 Robbins M, Verghese J. Acute painless progressive quadriplegia associated with warfarin use. J Am Geriatr Soc 2007; 55 (05) 799-800
• 10 Beynon C, Olivares A, Gumbinger C, Younsi A, Zweckberger K, Unterberg AW. Management of spinal emergencies in patients on direct oral anticoagulants. World Neurosurg 2019; 131: e570-e578
• 11 Mueck W, Stampfuss J, Kubitza D, Becka M. Clinical pharmacokinetic and pharmacodynamic profile of rivaroxaban. Clin Pharmacokinet 2014; 53 (01) 1-16
• 12 Chikuda H, Yasunaga H, Takeshita K. et al. Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database. Emerg Med J 2014; 31 (03) 201-206
• 13 Bracken MB, Shepard MJ, Holford TR. et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997; 277 (20) 1597-1604
• 14 Bamps S, Decramer T, Vandenbussche N. et al. Dabigatran-associated spontaneous acute cervical epidural hematoma. World Neurosurg 2015; 83 (02) 257-258
• 15 Mathais Q, Esnault P, Cruc M, Bernard C, Prunet B, Gaillard PE. Spontaneous cervical spinal epidural hematoma associated with dabigatran. World Neurosurg 2018; 112: 264-266
• 16 Ismail R, Zaghrini E, Hitti E. Spontaneous spinal epidural hematoma in a patient on rivaroxaban: case report and literature review. J Emerg Med 2017; 53 (04) 536-539
• 17 Jaeger M, Jeanneret B, Schaeren S. Spontaneous spinal epidural haematoma during Factor Xa inhibitor treatment (Rivaroxaban). Eur Spine J 2012; 21 (Suppl. 04) S433-S435
• 18 Castillo JM, Afanador HF, Manjarrez E, Morales XA. Non-traumatic spontaneous spinal subdural hematoma in a patient with non-valvular atrial fibrillation during treatment with rivaroxaban. Am J Case Rep 2015; 16: 377-381