Non‐contrast CT Markers of Hematoma Expansion and Andexanet Response in Factor Xa Inhibitor‐Associated Intracerebral Hemorrhage: An Analysis from ANNEXa ‐I Trial
Abstract
In this post hoc analysis of the ANNEXa-I trial (n = 434), we evaluated non-contrast computed tomography (NCCT) markers of hematoma expansion (HE) in factor Xa inhibitor (FXai) -associated intracerebral hemorrhage (ICH). At least one NCCT marker was present in 72.1%, and HE (≥12.5 mL or ≥ 35% increase in hematoma volume) occurred in 31.8%. Heterogeneous density, hypodensity, and the black hole sign were independently associated with HE. The effect of andexanet on HE was generally consistent across NCCT marker subgroups. These findings support the utility of NCCT markers for identifying patients at high risk of HE in FXai-associated ICH. ANN NEUROL 2026.
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Authors: Koji Tanaka, Umberto Pensato, Mohamed Alshamrani, Aristeidis H. Katsanos, Pargol Balali, Sucharita Ray, Scott E. Kasner, Jan Beyer‐Westendorf, Danilo Toni, David Seiffge, Carlos Molina, David Tanné, Anna Członkowska, Arne Lindgren, Daniel Bereczki, Else C. Sandset, Georgios Tsivgoulis, Prof Hanne Christensen, Jonathan M. Coutinho, Peter Verhamme, Pierre Amarenco, Robin Lemmens, Roland Veltkamp, Saskia Middeldorp, Thompson Robinson, Truman J. Milling, Wilfried Lang, Vitor Tedium‐Cruz, Mark Crowther, Lizhen Xu, Mikael Knutsson, Per Ladenvall, John W. Eikelboom, Mukul Sharma, Ashkan Shoamanesh, Andrew M. Demchuk
Institutions: University of Pennsylvania, Universidade do Porto, Imperial College London, KU Leuven, Amsterdam University Medical Centers, University of Calgary, Semmelweis University, Radboud University Nijmegen, The University of Texas at Austin, Skåne University Hospital, Bispebjerg Hospital, Lund University, Vall d'Hebron Hospital Universitari, University Hospital of Bern, Sapienza University of Rome, Humanitas University, IRCCS Humanitas Research Hospital, Rambam Health Care Campus, National and Kapodistrian University of Athens, University General Hospital Attikon, Radboud University Medical Center, Oslo University Hospital, Technische Universität Dresden, Population Health Research Institute, The University of Texas Health Science Center at Houston, Technion – Israel Institute of Technology, NIHR Leicester Biomedical Research Centre, Sigmund Freud Privatuniversität Wien, Hôpital Bichat-Claude-Bernard, AstraZeneca (Finland), AstraZeneca (Italy), Alfried Krupp Hospital, Institute of Psychiatry and Neurology, Texas Medical Center