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Real-world clinical decision of andexanet alfa administration for intracranial hemorrhage during anticoagulant therapy using factor Xa inhibitor Cover

Real-world clinical decision of andexanet alfa administration for intracranial hemorrhage during anticoagulant therapy using factor Xa inhibitor

Open Access
|Jan 2026

Figures & Tables

Fig. 1.

Clinical course of the study cases
Clinical course of the study cases

Fig 2.

88 year-old male with rivaroxaban intake. Traumatic intracerebral and intraventricular hemorrhages. Andexanet alfa was administered after hematoma expansion was observed at day 1. a: at ambulance, b: Day1 Right frontal intracerebral hematoma was enlarged., c: Day2, No hematoma expansion 24h after andexanet administration
88 year-old male with rivaroxaban intake. Traumatic intracerebral and intraventricular hemorrhages. Andexanet alfa was administered after hematoma expansion was observed at day 1. a: at ambulance, b: Day1 Right frontal intracerebral hematoma was enlarged., c: Day2, No hematoma expansion 24h after andexanet administration

Fig. 3.

82 year-old female with edoxaban intake. Right acute subdural hematoma. Andexanet administration. a: at ambulance, b: 14h after andexanet administration, c: 14 days after the ambulance.
82 year-old female with edoxaban intake. Right acute subdural hematoma. Andexanet administration. a: at ambulance, b: 14h after andexanet administration, c: 14 days after the ambulance.

Clinical characterisctics of patients

AndexanetUsual care
Number of patients 2326
Mean age 78.476.6
Gender (M/F) 8/1514/12

Past history
Hypertention2318
Atrial fibrillation183
Cerebrovascular disorders108

Location of spontaneous hemorrhage
Basal ganglia812
Cerebellum31
Pons20
Subcortex11

Diangnosis of traumatic hemorrhage
Contusional hematoma52
Acute subdural hematoma47
traumatic SAH03

Type of DOAC
Apixaban59
Rivaroxaban84
Edoxaban1013

Mean time from last dose to CT (hours) 9.79.6
1 to 10 hours1415
11 to 18 hours911

Hematoma volume (mL) 45.515.4
< 30 mL1021
30–80 mL830
> 80 mL51

Hematoma expansion or event of difficult hemostasis 14
Thromboenbolic events 2-
Outcome (mRS)0 to 3913
4 and 51110
633
DOI: https://doi.org/10.2478/jccm-2025-0046 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 78 - 83
Submitted on: Nov 11, 2024
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Accepted on: Oct 8, 2025
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Published on: Jan 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Shigeo Yamashiro, Keisuke Harada, Shunsuke Izumi, Yusuke Morikawa, Tomoko Ikemoto, Koki Kameno, Tomoaki Goto, Yuki Ohmori, Masatomo Kaji, Akitake Mukasa, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.