Spontaneous thoracic spinal subdural hematoma associated with apixaban therapy

Area of Science:

• Neurology
• Neurosurgery
• Hematology

Background:

• Spontaneous spinal subdural hematomas (SSDH) are exceptionally rare, often idiopathic, and distinct from more common epidural hematomas.
• Anticoagulation therapy, particularly coumarins, is a more frequent cause than direct factor Xa inhibitors like apixaban.
• Direct factor Xa inhibitors are more commonly associated with intracranial than spinal subdural hematomas.

Observation:

• A patient presented with a spontaneous thoracic spinal subdural hematoma.
• The hematoma was secondary to apixaban use and resulted in severe neurological deficits, including loss of sphincter control and paraplegia.

Findings:

• The case details a rare instance of SSDH linked to apixaban.
• Despite severe neurological deficits, the patient underwent treatment and showed a complete recovery.

Implications:

• This case underscores the importance of considering direct factor Xa inhibitors, such as apixaban, as potential causes of SSDH.
• Prompt diagnosis and management are crucial for favorable outcomes in patients with neurological deficits secondary to spinal subdural hematomas.
• Further research may be warranted to elucidate the specific mechanisms and risk factors associated with apixaban-induced SSDH.