New oral anticoagulants-induced spinal epidural haematomas: case series and review of literature

Spontaneous spinal epidural haematoma (SSEH) is a rare cause of acute spinal cord compression. This condition is often associated with use of anticoagulant drugs, coumarins or new oral anticoagulants, such as direct factor Xa inhibitor and direct thrombin inhibitor. The manifestation of severe neurological deficits is common and can lead to catastrophic consequences if not diagnosed early. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Due to the rarity of this pathologic entity, only sporadic case reports and associated reviews are available. We report a case series of 4 patients diagnosed with spontaneous spinal epidural haematoma induced by new oral anticoagulants. Spontaneous spinal haematoma is a rare pathologic entity and therefore difficult to diagnose. For patients receiving long term anti-coagulant therapy, SSEH should be included in the differential diagnosis. Prompt surgical evacuation of the haematoma and haemostasis leads to favourable neurological outcome, whereas delay in treatment can be disastrous.