Spontaneous spinal subdural haematoma in a patient on apixaban

A 68-year-old man on apixaban presented to the emergency department with back pain following a long-haul flight. He was initially discharged with analgesia for mechanical back pain, but presented three more times with worsening symptoms. Further investigation revealed a spinal subdural haematoma, which was managed conservatively. He was discharged for rehabilitation with good neurological recovery. This case highlights the importance of considering iatrogenic haemorrhage in anticoagulated patients presenting with pain and neurological symptoms, and the potential for conservative management in certain cases of spontaneous spinal subdural haematoma.

• 1
  The patient's spinal subdural haematoma was initially missed, leading to multiple presentations and worsening symptoms.
• 2
  Conservative management, rather than surgical intervention, led to a good neurological recovery in this case.
• 3
  The case highlights the potential for delayed diagnosis of spontaneous spinal subdural haematoma in patients on apixaban.