Could dual anticoagulation with Rivaroxaban have precipitated a Spinal Epidural Hematoma: from independent mobility to paraplegia
Bibliographic record
Abstract
A 81 year-old male, with atrial fibrillation (AF) and a prosthetic valve on aspirin and rivaroxaban, presented with acute back pain, limb weakness and paraplegia within six hours. Urgent spine magnetic resonance imaging (MRI) showed a massive epidural bleed from T1 – T12. A spontaneous spinal epidural hematoma (SSEH) was diagnosed. The patient was not a surgical candidate as the cord had infarcted and the risk of a fatal intra-operative bleed was high. He was ultimately transferred for rehabilitation on aspirin. His spinal cord injury was graded as T10 ASIA B. Anticoagulation was never restarted and the patient awaits an atrial appendage closure to reduce the risk of clot formation. To our knowledge, this is the first report of a long segment SSEH and adverse reaction to rivaroxaban with an unusually rapid and permanent neurologic sequelae.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".