Molina Michelle, Hillard Virany H, Fekete Robert
Department of Neurology, New York Medical College , Valhalla, NY, USA.
Hematol Rep. 2014 Mar 28;6(1):5283. doi: 10.4081/hr.2014.5283. eCollection 2014 Jan 29.
Rivaroxaban is an oral factor Xa inhibitor used for stroke prevention in atrial fibrillation. There are currently no evidence-based guidelines for the treatment of hemorrhagic side effects of factor Xa inhibitors. We report a case of a thalamic hemorrhage in an 84 year-old right-handed female on rivaroxaban for treatment of atrial fibrillation. The patient had fallen down steps and became unresponsive. She was found to have diffuse scattered acute subarachnoid hemorrhage as well as intraventricular hemorrhage. Neurosurgical intervention was not required in this case, but controversy over decision making to pursue pro-coagulant therapy in the setting of worsening hemorrhage requiring emergent surgery is discussed.
利伐沙班是一种口服Xa因子抑制剂，用于预防心房颤动患者的中风。目前尚无基于证据的Xa因子抑制剂出血副作用治疗指南。我们报告一例84岁右利手女性，因心房颤动接受利伐沙班治疗，发生丘脑出血。患者从楼梯上摔倒后失去意识。发现其有弥漫性散在急性蛛网膜下腔出血及脑室内出血。本例无需神经外科干预，但讨论了在出血恶化需要紧急手术的情况下，进行促凝血治疗决策的争议。
