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A rare case of non-traumatic spinal epidural hematoma in lumbar region associated with apixaban therapy

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Abstract

Spontaneous spinal epidural hematoma (SSEH) is a very rare clinical entity with potential diagnostic difficulties and which can result in severe neurological deficit. The etiology of this rare condition is largely not known, but with potential predisposition in patients on anticoagulation medication. This includes the novel anticoagulants with direct inhibition of the factor Xa mechanism (DOACs). These medications are supposed to have more predictable pharmacokinetics with fewer severe haemorrhagic adverse events in comparison with standard warfarin therapy. However, in the last few years, an increasing number of case reports have been published of haemorrhage into the central nervous system. We present a case of non-traumatic spinal epidural hematoma in the lumbar region in a patient on chronic apixaban therapy. To the best of our knowledge, it is the first described SSEH in the lumbar region associated with apixaban therapy.

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Funding

This work was supported by a grant from Charles University, Czech Republic (PROGRES Q40 04).

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Authors and Affiliations

  1. Department of Neurosurgery, Charles University Medical Faculty and Faculty Hospital, Hradec Králové, Czech Republic

    Petr Krupa, Martin Kanta, Tomas Hosszu & Tomas Cesak

  2. Department of Neuroregeneration, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic

    Petr Krupa

  3. The Fingerland Department of Pathology, Charles University Medical Faculty and Faculty Hospital Hradec Kralove, Hradec Králové, Czech Republic

    Jiri Soukup

  4. Department of Radiology, Charles University Medical Faculty and Faculty Hospital Hradec Kralove, Hradec Králové, Czech Republic

    Pavel Ryska

  5. Fourth Department of Internal Medicine and Hematology, Charles University Medical Faculty and Faculty Hospital Hradec Kralove, Hradec Králové, Czech Republic

    Petr Dulicek

Authors
  1. Petr Krupa
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  2. Martin Kanta
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  3. Tomas Hosszu
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  4. Jiri Soukup
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  5. Pavel Ryska
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  6. Petr Dulicek
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  7. Tomas Cesak
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Contributions

PK: surgery, data acquisition, literature revision, manuscript writing, supervision. MK: surgery, manuscript writing, critical revision of manuscript for intellectual content related to neurosurgery; TH: manuscript writing, critical revision of manuscript for intellectual content related to neurosurgery; JS: manuscript writing, critical revision of manuscript for intellectual content related to pathology; PR: manuscript writing, critical revision of manuscript for intellectual content related to radiology; PD: manuscript writing, critical revision of manuscript for intellectual content related to haematology; TC: manuscript writing and critical revision for intellectual content.

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Correspondence to Petr Krupa.

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The authors declare they have no conflict of interest.

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The patient provided written informed consent to the submission of the case report to the journal.

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Krupa, P., Kanta, M., Hosszu, T. et al. A rare case of non-traumatic spinal epidural hematoma in lumbar region associated with apixaban therapy. J Thromb Thrombolysis 52, 1215–1219 (2021). https://doi.org/10.1007/s11239-021-02462-y

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  • DOI: https://doi.org/10.1007/s11239-021-02462-y

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