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December 14, 1970

Spinal Meningeal Hematoma, Warfarin Therapy, and Chiropractic Adjustment

Author Affiliations

San Diego, Calif

JAMA. 1970;214(11):2058. doi:10.1001/jama.1970.03180110066020

To the editor.—  Long-term anticoagulant therapy is used frequently for treatment and prevention of thrombosis and embolism.Spontaneous spinal hematoma is rare in the absence of trauma, vascular tumor, pregnancy, or anticoagulation therapy.1-7Jackson,2 in 1869, described a spontaneous extradural hematoma in a 14-year-old boy. More recently, Strain3 noted that out of 34 patients recorded in the medical literature in 1963, spinal hematoma occurred in six that had been receiving anticoagulant therapy. While extradural hematoma was found more frequently, Cloward4 presented a case that included intradural and subarachnoid bleeding.Our case provides a warning to patients receiving anticoagulant therapy to abstain from manipulations of the spine.

Report of Case.—  A 54-year-old woman was admitted to the hospital for pain in the back. Five days earlier, she had visited a chiropractor because of recurrence of the pain in the lower part of the back which she had