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September 10, 2026Annals of Neurology0 citationsOpen Access

Non‐contrast CT Markers of Hematoma Expansion and Andexanet Response in Factor Xa Inhibitor‐Associated Intracerebral Hemorrhage: An Analysis from ANNEXa ‐I Trial

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KTKoji TanakaUPUmberto PensatoMAMohamed Alshamrani

Key Result

Non-contrast CT markers were present in 72.1% of patients and independently associated with hematoma expansion, which occurred in 31.8% of patients with FXa inhibitor-associated ICH.

Key Points

  • To evaluate whether non-contrast computed tomography (NCCT) markers predict hematoma expansion and influence the therapeutic efficacy of andexanet in factor Xa inhibitor-associated intracerebral hemorrhage.
  • Conducted a post hoc analysis of the multicenter ANNEXa-I trial in patients with factor Xa inhibitor-associated intracerebral hemorrhage (n = 434).
  • Evaluated baseline NCCT imaging markers and defined hematoma expansion as an absolute volume increase of ≥12.5 mL or a relative increase of ≥35%.
  • At least one NCCT marker was present in 72.1% of patients at baseline, and hematoma expansion occurred in 31.8% of the cohort.
  • Heterogeneous density, hypodensity, and the black hole sign were each independently associated with hematoma expansion.
  • The therapeutic effect of andexanet on limiting hematoma expansion was generally consistent across all evaluated NCCT marker subgroups.

Study Design

Type

Observational (n=434)

Structured PICO

Do non-contrast CT markers predict hematoma expansion and response to andexanet in patients with factor Xa inhibitor-associated intracerebral hemorrhage?

P
Population
434 patients with factor Xa inhibitor-associated intracerebral hemorrhage analyzed for non-contrast CT markers of hematoma expansion.
E
Exposure
Andexanet
O
Outcome
Hematoma expansion (HE) (≥12.5 mL or ≥ 35% increase in hematoma volume)surrogate

Non-contrast CT markers such as heterogeneous density, hypodensity, and the black hole sign can identify patients at high risk of hematoma expansion in FXa inhibitor-associated ICH.

Limitations

  • post hoc analysis

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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Cite This Study

Tanaka et al. (2026) conducted an observational in Factor Xa inhibitor-associated intracerebral hemorrhage (n=434). Non-contrast computed tomography (NCCT) markers was evaluated on Hematoma expansion (≥12.5 mL or ≥ 35% increase in hematoma volume). Non-contrast CT markers were present in 72.1% of patients and independently associated with hematoma expansion, which occurred in 31.8% of patients with FXa inhibitor-associated ICH.

synapsesocial.com/papers/6aa27a8e58559d80afc7329ahttps://doi.org/10.1002/ana.78347
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