Trauma induced spinal subdural haematoma in patient anticoagulated with apixaban

Vela Pascual, R.C.; Sánchez-Pedrosa, G.; Rodríguez Rodríguez, L.

doi:10.1016/j.redare.2020.10.013

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Rodríguez Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R.C." "apellidos" => "Vela Pascual" "email" => array:1 [ 0 => "r.velapascual@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Sánchez-Pedrosa" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Rodríguez Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hematoma subdural espinal postraumático en paciente anticoagulada con apixabán" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 794 "Ancho" => 1007 "Tamanyo" => 184325 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "T10-L1 decompressive laminectomy. A) Blood collection in the spinal space. B) Complete evacuation of the spinal haematoma with exposure of the spinal cord." ] ] ] "textoCompleto" => "A 78-year-old woman with atrial fibrillation anticoagulated with apixaban presented at the emergency room with a 3-day history of low back pain and urine retention. She reported falling over 3 weeks ago. She had gone to another hospital on the day the symptoms began and received a diagnosis of urinary tract infection and acute urine retention. The bladder had been drained and antibiotic therapy started. She presented at our hospital with sensorimotor impairment in the lower limbs. Suspecting a vertebral fracture, a spine CT was performed, which showed a spinal haematoma, so urgent spine MRI was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Labs were only remarkable for prolonged prothrombin time (PT) (20.9 s) and an INR of 1.75.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Given the results of the complementary tests, the patient was transferred to the operating room for urgent decompressive laminectomy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Due to the high risk of bleeding, apixaban was reversed before the intervention. It is important to note that normal PT does not rule out apixaban anticoagulation, and that changes in PT are not directly related to the activity of the drug. As there was no specific apixaban antidote available (andexanet alfa), coagulation was reversed by administering 1500 IU (25 U/kg) of a 4-factor prothrombin complex concentrate." 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ISSN: 2341-1929

Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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