A case of thalamic hemorrhage which occurred during anticoagulant therapy with Xa inhibitor and expanded even after the administration of prothrombin complex concentrate

Abstract

An 82-year-old man treated with rivaroxaban 10 mgQD for prevention of stroke associated with nonvalvular atrial fibrillation developed left thalamic hemorrhage with symptoms of consciousness disturbance and right hemiparesis and was transferred to our hospital after about 2 hours and 3 hours of taking tablet, respectively. Head computed tomography (CT) examination demonstrated the left thalamic hemorrhage with size of 10 ml. Immediately, administration of antihypertensive agents was started to keep systolic blood pressure below 140 mmHg and 1,000 IU of prothrombin complex concentrate (PCC) was administered which reversed prothrombin time-international normalized ratio (PT-INR) from 1.33 to 1.14. However, the size of hematoma grew up to be 21 ml and 23 ml after 3 hours and 5 hours after the admission, respectively. It seems that lowering blood pressure and administration of PCC may be ineffective against hematoma expansion in brain hemorrhage occurring within a couple of hours after taking rivaroxaban.