Expert’s comment concerning Grand Rounds case entitled “Retroperitoneal haematoma in a postoperative ALIF patient taking rivaroxaban for atrial fibrillation” by Deekonda P, Stokes OM, Chan D (Eur Spine J : DOI 10.1007/s00586-016-4822-8)
This is a clear and well-constructed case report describing retroperitoneal haemorrhage in a 72-year-old man taking the oral anticoagulant, rivaroxaban, shortly after spinal surgery and a related literature review . The authors describe the patient’s presentation and bleeding management as well as summarise some key issues around NOACs and surgery.
Rivaroxaban directly inhibits factor Xa, a vital enzyme in the clotting pathway. Its onset of action is rapid, peaking at 2–4 h after ingestion, and with an elimination half-life of around 12 h or less, anticoagulation has generally worn off within 48–72 h of last exposure . I will make some specific comments on the peri-operative management of rivaroxaban and the emergency management of major haemorrhage associated with NOACs.
The authors rightly point out that specific reversal agents are needed, with none available at the time of their report. It is common for guidelines on managing NOAC-associated bleeding to...
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Conflict of interest
The author declares that he has no conflict of interest.
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