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(dabigatran, pradaxa) and anti-Xa (rivaroxaban, apixaban, edoxaban), are the most recently introduced anticoagulants. Compared to warfarin, DOAC has a faster onset, predictable therapeutic range, shorter half-life [1], and relatively lesser interaction with other medicines and foods. It can be easily administered in a fixed dose as an oral preparation without blood coagulation monitoring [2]. Therefore, there has been a surge in its use in patients with non-valvular atrial fibrillation and in recurrent venous thromboembolism. Recently, rivaroxaban has proved effective in preventing symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) after hip or knee arthroplasty and its use for this purpose has shown an increased trend [3]. However, since postoperative bleeding may occur at the surgical site or at the site of regional anesthesia, careful use is necessary with respect to each individual patient and the usage guidelines. In this report, we present a case of a patient who developed a symptomatic epidural hematoma after postoperative administration of rivaroxaban and the need to consider extreme caution in its use for epidural anesthesia in hip or knee arthroplasty.

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