Spontaneous thoracolumbar epidural hematoma in an apixaban anticoagulated patient

Andreas Theofanopoulos; Petros Zampakis; Eleftheria Antoniadou; Dimitrios Papadakos; Dionysia Fermeli; Constantine Constantoyannis; Lambros Messinis; Vasileios Panagiotopoulos

doi:10.25259/SNI_434_2021

Spontaneous thoracolumbar epidural hematoma in an apixaban anticoagulated patient

Surg Neurol Int. 2021 Jun 7:12:256. doi: 10.25259/SNI_434_2021. eCollection 2021.

Authors

Andreas Theofanopoulos¹, Petros Zampakis², Eleftheria Antoniadou³, Dimitrios Papadakos¹, Dionysia Fermeli¹, Constantine Constantoyannis¹, Lambros Messinis⁴, Vasileios Panagiotopoulos⁵

Affiliations

¹ Department of Neurosurgery, University of Patras, University Hospital of Patras, Achaia, Greece.
² Department of Radiology and Interventional Neuroradiology, University of Patras, University Hospital of Patras, Achaia, Greece.
³ Department of Rehabilitation, Rehabilitation Clinic, University of Patras, University Hospital of Patras, Achaia, Greece.
⁴ Department of Neurology and Psychiatry, Neuropsychology Section, University of Patras, University Hospital of Patras, Patras, Achaia, Greece.
⁵ Department of Neurosurgery and Endovascular Neurosurgery, University of Patras, University Hospital of Patras, Patras, Achaia, Greece.

Abstract

Background: Spontaneous spinal epidural hematomas (SSEHs) are often attributed to anticoagulation. Although they are rare, they may contribute to significant morbidity and mortality.

Case description: An 83-year-old female with a history of atrial fibrillation on apixaban, presented with 4 days of back pain, progressive lower extremity weakness and urinary retention. When the patient's MRI showed a dorsal thoracolumbar SSEH, the patient underwent a T10-L3 laminectomy for hematoma evacuation. Within 2 postoperative months, her neurological deficits fully resolved.

Conclusion: Apixaban is associated with SSEH resulting in severe neurological morbidity and even mortality. Prompt MRI imaging followed by emergency surgical decompressive surgery may result in full resolution of neurological deficits.

Keywords: Apixaban; SSEH; Spontaneous spinal epidural hematoma.

Publication types

Case Reports