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Trauma induced spinal subdural haematoma in patient anticoagulated with apixaban
Hematoma subdural espinal postraumático en paciente anticoagulada con apixabán
R.C. Vela Pascual
, G. Sánchez-Pedrosa, L. Rodríguez Rodríguez
Corresponding author
Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sánchez-Pedrosa, L. 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" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">T10-L1 decompressive laminectomy. A) Blood collection in the spinal space. B) Complete evacuation of the spinal haematoma with exposure of the spinal cord.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">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>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vela Pascual RC, Sánchez-Pedrosa G, Rodríguez Rodríguez L. Hematoma subdural espinal postraumático en paciente anticoagulada con apixabán. Rev Esp Anestesiol Reanim. 2022;69:62–63.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1263 "Ancho" => 1007 "Tamanyo" => 99124 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI of the dorsal lumbar spine without contrast, STIR sequence. A subdural haematoma compressing the spinal cord can be seen in segments T10-L1.</p>" ] ] 1 => 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" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">T10-L1 decompressive laminectomy. A) Blood collection in the spinal space. 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