Spontaneous thoracolumbar epidural hematoma in an apixaban anticoagulated patient

Background Spontaneous spinal epidural hematomas (SSEHs) are often attributed to anticoagulation. Although they are rare, they may contribute to significant morbidity and mortality. Case Description An 83-year-old female with a history of atrial fibrillation on apixaban, presented with 4 days of back pain, progressive lower extremity weakness and urinary retention. When the patient's MRI showed a dorsal thoracolumbar SSEH, the patient underwent a T10-L3 laminectomy for hematoma evacuation. Within 2 postoperative months, her neurological deficits fully resolved. Conclusion Apixaban is associated with SSEH resulting in severe neurological morbidity and even mortality. Prompt MRI imaging followed by emergency surgical decompressive surgery may result in full resolution of neurological deficits.