Spinal Cord Compression Secondary to a Spontaneous Spinal Haematoma in a Patient Newly Treated with Rivaroxaban

A 74-year-old patient anticoagulated with rivaroxaban for chronic atrial fibrillation presented to the emergency department with acute lumbar pain with progressive weakness of the lower limbs and inability to stand up. No previous trauma was reported. Neurological examination was consistent with a complete spinal cord syndrome at the level of T6. Magnetic resonance imaging showed the presence of spinal cord compression associated with signs of extensive intramedullary inflammation secondary to a haematoma. The patient underwent thoracic laminectomy with evacuation of an intradural haematoma. No intraoperative complications were described, but no clinical improvement had been achieved 15 days after the surgical intervention.

Apixaban could be preferred as the first choice for direct oral anticoagulation (DOAC) in older patients.DOACs can have important side effects even if the switch from vitamin K antagonist to this group is correctly carried out.