A patient with an acute traumatic subdural hematoma chronically treated with rivaroxaban – a challenge for neurosurgeons

Abstract

Rivaroxaban (Xareltoâ), selective direct inhibitor of activated clotting factor Xa belongs to the new oral anticoagulatns (NOACs). Rivaroxaban works to inhibit thrombin formation, and the interruption of the intrinsic and extrinsic pathway of blood coagulation and is strongly dose-dependent. It prolongs Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) without influence on bleeding time and platelet aggregation. It is indicated as a prophylactic to cerebral infarction and peripheral thrombosis in adults with nonvalvular atrial fibrillation as well as the treatment and secondary prevention of deep vein thrombosis and pulmonary thromboembolism. We are presenting a case of an elderly female patient chronically treated with rivaroxaban, who was qualified for neurosurgical treatment in a life threatening state due to an acute subdural hematoma. Despite the lack of unequivocal guidelines for pharmacological and surgical management in cases of intracranial haemorrhage in adults whom are chronically treated with direct factor Xa inhibitors, we managed to obtain a favourable outcome.