BRIEF RESEARCH REPORT article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1628563
Predictors of Hematoma Expansion in Intracerebral Hemorrhage Associated with Factor Xa Inhibitors
Provisionally accepted
- Hitachi General Hospital, Ibaraki, Japan
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Background Improving the outcomes of patients with intracerebral hemorrhage (ICH) associated with factor Xa inhibitors remains a clinical challenge. Andexanet alfa, a specific reversal agent for factor Xa inhibitors, has the potential to mitigate hematoma expansion (HE). The aim of this study is to identify predictors of HE in ICH associated with factor Xa inhibitor use and to propose appropriate indications for reversal therapy. Methods This was a single-center, retrospective observational study that included 68 consecutive patients who developed ICH within 24 hours of factor Xa inhibitor intake and were not receiving concomitant antiplatelet therapy. The study period spanned from April 2012 to June 2022. The relationships between HE and patient-related, clinical, hematoma-related, and pharmacological factors were examined. Results HE was observed in 18 cases (26.5%) and significantly worsened outcomes (p=0.028). In univariate analysis, significant predictors of HE were an irregular margin and/or heterogeneity of the hematoma on computed tomography (CT) (p = 0.009), an initial CT performed within 4 hours after drug intake (p = 0.034), and edoxaban use (p = 0.041). A multivariate analysis identified hematoma morphology on CT (p=0.030) and the initial CT within 4 hours after drug intake (p=0.048) as significant predictors. Hematoma volume, interval from onset to initial CT, and coagulation-related laboratory parameters were not significant. Conclusions The predictors of HE were an irregular margin or heterogeneous hematoma, and an initial CT performed within 4 hours after drug intake. Reversal decisions based on hematoma volume, or interval from onset to initial CT may be inappropriate.
Keywords: intracerebral hemorrhage, Hematoma expansion, Direct oral anticoagulant, Factor Xa inhibitor, andexanet alfa
Received: 14 May 2025; Accepted: 17 Oct 2025.
Copyright: © 2025 Komatsu, Koiso, Sekine, Akutagawa, Karita, Kikuchi and Yamazaki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yoji Komatsu, yoji.komatsu.fn@hitachi.com
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