Key result
The use of pro-haemostatic agents did not significantly alter bleeding-related mortality in patients with factor Xa inhibitor-associated intracranial haemorrhages (90% vs 93%, p=0.356).
Why the study?
Optimal management of factor Xa inhibitor-associated intracranial haemorrhages remains uncertain, particularly regarding the efficacy of pro-haemostatic agents.
Does the use of pro-haemostatic agents reduce bleeding-related mortality or ICH volume expansion in patients with factor Xa inhibitor-associated intracranial haemorrhages?
Cohort (n=150)
Yes
Does the use of pro-haemostatic agents reduce bleeding-related mortality or ICH volume expansion in patients with factor Xa inhibitor-associated intracranial haemorrhages?
In real-world practice, the administration of pro-haemostatic agents for factor Xa inhibitor-associated intracranial haemorrhage did not significantly reduce bleeding-related mortality or haematoma expansion.
No mortality benefit seen with pro-haemostatic agents in this cohort; challenges prior reports and leaves open efficacy pending randomized trials.
BACKGROUND: An increasing number of patients in Australia are taking direct oral anticoagulants for a variety of indications since their introduction in the treatment landscape. There has always been some concern about the optimal management approach in the setting of major and/or life-threatening bleeding. In particular, patients who present with factor Xa inhibitor-associated intracranial haemorrhages are associated with high morbidity and mortality. AIM: To determine the efficacy of pro-haemostatic agents in the management of factor Xa inhibitor-related intracranial haemorrhages. METHODS: A retrospective audit of rivaroxaban and apixaban-associated intracranial haemorrhages was performed between January 2015 and December 2021, inclusive. RESULTS: The bleeding-related mortality was similar between the patients who received pro-haemostatic agents versus patients who did not receive pro-haemostatic agents (90% vs 93% respectively). The mean volume expansion for those who received pro-haemostatic agents was +1.0mL versus -6.8 mL for patients who did not receive pro-haemostatic agents (P = 0.51, 95% confidence interval: -11.7 to +5.9). CONCLUSION: Patients who presented with intracranial haemorrhages in the presence of clinically significant direct oral anticoagulant levels had a higher risk of mortality that does not appear to change with the use of prohaemostatic agents. The efficacy of prohaemostatic agents may not be as clinically significant based on real-world experience in contrast to previously reported studies.
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Ng et al. (2025) conducted a cohort in Factor Xa inhibitor-associated intracranial haemorrhages (n=150). Pro-haemostatic agents vs. No pro-haemostatic agents was evaluated on Bleeding-related mortality (p=0.356). The use of pro-haemostatic agents did not significantly alter bleeding-related mortality in patients with factor Xa inhibitor-associated intracranial haemorrhages (90% vs 93%, p=0.356).
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