Ismail Raed, Zaghrini Elie, Hitti Eveline
American University of Beirut, Beirut, Lebanon.
J Emerg Med. 2017 Oct;53(4):536-539. doi: 10.1016/j.jemermed.2017.06.005.
Spinal hematomas (SHs) are rare yet potentially debilitating causes of acute back pain. Although spontaneous SHs have been described in the setting of anticoagulation with warfarin or enoxaparin, few cases of spontaneous SH on direct oral anticoagulants (DOACs) have been reported.
We report a case of spontaneous spinal epidural hematoma in a patient on rivaroxaban. A 72-year-old man on rivaroxaban and aspirin presented with a 4-day history of nontraumatic back pain. In the emergency department he developed lower-extremity weakness and numbness, followed by urinary incontinence. Magnetic resonance imaging revealed spinal epidural hematoma at T11-L2. The patient underwent emergent decompression and hematoma evacuation and was discharged home 8 days later with complete resolution of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recognition and surgical intervention for SHs with neurologic compromise is key to favorable outcome. Optimal timing of surgery in patients on DOACs requires an assessment of the risk of intraoperative or postoperative bleeding, an assessment of the patient's symptom progression, as well as an understanding of the pharmacokinetics of the DOAC used and possible reversal options available. We also review all published cases of spontaneous SHs in patients on DOACs and report on their management and outcomes.
脊髓血肿（SHs）是急性背痛的罕见但可能使人衰弱的病因。尽管已有华法林或依诺肝素抗凝治疗时发生自发性SHs的报道，但直接口服抗凝剂（DOACs）导致自发性SHs的病例报道较少。
我们报告1例服用利伐沙班的患者发生自发性脊髓硬膜外血肿的病例。1名服用利伐沙班和阿司匹林的72岁男性，有4天非创伤性背痛病史。在急诊科，他出现下肢无力和麻木，随后出现尿失禁。磁共振成像显示T11-L2水平脊髓硬膜外血肿。患者接受了急诊减压和血肿清除术，8天后出院，症状完全缓解。急诊医生为何应了解此情况？：对于伴有神经功能损害的SHs，早期识别和手术干预是取得良好预后的关键。DOACs治疗患者的最佳手术时机需要评估术中或术后出血风险、评估患者症状进展情况，以及了解所用DOACs的药代动力学和可用的可能的逆转方法。我们还回顾了所有已发表的DOACs治疗患者发生自发性SHs的病例，并报告了其治疗方法和结果。
