Anesth Pain Med.  2019 Jan;14(1):102-105. 10.17085/apm.2019.14.1.102.

Epidural hematoma after total knee arthroplasty in a patient receiving rivaroxaban: A case report

• Shin S
• Kang H
• Lee JW
• Kim HG
• Choi ES

• KMID: 2434207
• DOI: http://doi.org/10.17085/apm.2019.14.1.102

Abstract

Rivaroxaban, a factor Xa inhibitor, is one of the newly developed direct oral anticoagulants (DOAC). In recent times, it has been increasingly used in the prevention of pulmonary embolism in patients undergoing orthopedic surgery. This report describes a case of epidural hematoma in an elderly patient who underwent combined spinal epidural anesthesia for total knee arthroplasty; the patient received rivaroxaban postoperatively for 7 days to prevent pulmonary embolism. Additionally, the epidural hematomas developed on the 5th postoperative day but the patient recovered well with conservative treatment. Although rivaroxaban has a low need for monitoring and is easily administered, the guidelines should be carefully checked for the postoperative administration schedule in patients undergoing regional anesthesia. In addition, rivaroxaban should be used with caution, especially in elderly patients.

Keyword

Anticoagulants; Conduction anesthesia; Spinal epidural hematoma

MeSH Terms

Aged
Anesthesia, Conduction
Anesthesia, Epidural
Anticoagulants
Appointments and Schedules
Arthroplasty, Replacement, Knee*
Factor Xa
Hematoma*
Hematoma, Epidural, Spinal
Humans
Orthopedics
Pulmonary Embolism
Rivaroxaban*
Anticoagulants
Factor Xa
Rivaroxaban

Figure

• 

  Fig. 1 Sagittal lumbar magnetic resonance imaging revealing a dorsal epidural hematoma at the L3–5 vertebral level (arrow).

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