Hematoma Volume in Apixaban vs. Rivaroxaban-Related Intracerebral Hemorrhage.

BACKGROUND/

OBJECTIVE

Among patients with intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) use, it is unknown whether hematoma volume differs according to DOAC agent. The primary objective of our study was to compare baseline hematoma volume between apixaban and rivaroxaban-related ICH.

METHODS

We evaluated consecutive patients with apixaban- and rivaroxaban-related spontaneous ICH admitted to a tertiary hospital between 2013 and 2024. We recorded baseline hematoma volume, hematoma expansion (> 6 cc or > 33%), and hospital mortality.

RESULTS

The cohort comprised 136 patients (age, median [IQR] 81 [73-87] years, 68 female [50.0%]); of whom 91 (66.9%) were taking apixaban and 45 (33.1%) were taking rivaroxaban at the time of the index ICH. There were no differences in demographics, comorbidities, or antiplatelet pretreatment between apixaban and rivaroxaban. Lobar hemorrhage location was more frequent with rivaroxaban (46.7% vs. 28.6%, P = 0.037). Rivaroxaban-related ICH patients had larger median baseline hematoma volumes (22.8 [8.0-58.0] mL vs. 12.2 [2.5-31.2] mL; P = 0.003) compared with apixaban. In multivariable linear regression analysis, rivaroxaban was independently associated with larger baseline hematoma volume (standardized linear regression coefficient: 0.581 [95% CI 0.146-1.015]; P = 0.009). Hematoma expansion (40.0% vs. 23.7%; P = 0.131) and hospital mortality (40.0% vs. 29.8%; P = 0.240) were similar between rivaroxaban and apixaban.

CONCLUSIONS

Compared with apixaban, rivaroxaban pretreatment was independently associated with larger baseline hematoma volume in patients with spontaneous ICH. These findings require validation in larger cohort studies.