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Spontaneous Cervical Spinal Epidural Hematoma Associated with Dabigatran
Quentin Mathais1, Pierre Esnault1, Maximilien Cruc1
1Department of Anesthesiology and Intensive Care, Military Hospital Sainte Anne, Toulon, France.
World Neurosurgery
|February 10, 2018
Summary
Spinal epidural hematomas are rare but can occur with anticoagulants. This case highlights successful treatment of a spontaneous spinal epidural hematoma in a patient on dabigatran using idarucizumab.
Area of Science:
- Neurology
- Hematology
Background:
- Spontaneous spinal epidural hematomas (SSEH) are uncommon neurological emergencies.
- Vitamin K antagonists (VKAs) are known risk factors for SSEH.
- Non-vitamin K antagonist oral anticoagulants (NOACs) represent a growing class of anticoagulants with different risk profiles.
Observation:
- A patient on dabigatran, a NOAC, developed SSEH.
- Initial symptoms of hemiparesis were misdiagnosed and later identified as Brown-Séquard syndrome.
- SSEH diagnosis was confirmed in a patient treated with dabigatran.
Findings:
- Immediate antagonism of dabigatran with idarucizumab was administered.
- Surgical decompression via posterior cervical laminectomy was performed.
- Complete neurological recovery was observed within 4 days post-intervention.
Implications:
- This is the first reported case of SSEH in a patient on NOAC therapy.
- Successful antagonism of dabigatran with idarucizumab is demonstrated.
- Highlights the importance of developing specific antidotes for NOACs in managing anticoagulant-related emergencies.
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