Paraplegia Caused by Spontaneous Spinal Hemorrhage in a Patient Undergoing Rivaroxaban Therapy.

BACKGROUND Spinal hematomas can be post-traumatic, iatrogenic, or spontaneous. A spontaneous spinal hematoma is a rare finding, but one with very serious clinical implications. There are some risk factors linked to its occurrence, e.g. arteriovenous malformations, lumbar puncture, coagulopathy, neoplasms, or therapeutic anticoagulation. At present, only a few cases of spontaneous spinal hematoma (SSH) associated with new oral anticoagulants (NOACs) have been described, three of which were linked with rivaroxaban. CASE REPORT We report the case of an 82-year-old Caucasian woman with persistent atrial fibrillation treated with rivaroxaban, who presented to the Urology Department with acute-onset back pain which was thought to be due to urolithiasis. No kidney stones were found, but her creatinine serum level was elevated, so she was transferred to our clinic for further treatment. During hospitalization she quickly developed paraplegia with urine and stool retention. MRI was performed, and demonstrated an acute epidural hemorrhage in her thoracic and lumbar spine. The neurosurgeons disqualified this patient from surgical intervention due to the extent of the hematoma and its location. The patient was referred to the Neurology Department for treatment and rehabilitation, but, to the best of our knowledge, she did not recover her motor function. CONCLUSIONS Although rivaroxaban has been shown to be more effective than warfarin in stroke prevention in patients with atrial fibrillation, physicians must remember that its use also carries the risk of major bleeding. SSH occurrence should be taken into account in a patient taking NOACs who develops paraplegia, even if there is no history of trauma prior to admission.

Lack of association of C599T polymorphism in the glutathione peroxidase (GPX1) gene with delayed graft function, acute kidney graft rejection and chronic allograft nephropathy.

BACKGROUND: The glutathione peroxidase/glutathione system is a major defense in oxidative stress. Glutathione peroxidase (GPx) is a selenium-containing antioxidant enzyme that effectively reduces hydrogen peroxide and lipid peroxides to water and lipid alcohols, respectively, and in turn oxidizes glutathione to glutathione disulfide. Previous studies have shown that the activity of glutathione peroxidase is genetically determined and is associated with polymorphisms in GPX1 gene. The aim of the present study was to examine the association between the C599T polymorphism in the glutathione peroxidase (GPX1) gene and delayed graft function of kidney allografts, acute rejection and chronic allograft nephropathy. MATERIAL/METHODS: One hundred eighty-seven recipients of first cadaveric renal transplants from the Department of Nephrology, Transplantology and Internal Medicine of Pomeranian Medical University were included in this retrospective study. Genotyping of C599T polymorphism in the GPX1 gene was performed using PCR-RFLP method. RESULTS: There were no significant associations between this polymorphism and delayed graft function, acute rejection and chronic allograft nephropathy. CONCLUSIONS: The present results suggest that GPX1 C599T polymorphism has no influence on the graft function in the first phase after transplantation, as well as on the acute kidney graft rejection and chronic allograft nephropathy.