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Updated: Aug 6, 2026
06:30
Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI)
Published on: December 16, 2021
Hematoma Volume in Apixaban vs. Rivaroxaban-Related Intracerebral Hemorrhage
Mitch Wilson1, Stephanie Vu2, Elizabeth Heistand2
1Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215-5491, USA. mitch.wilson857@gmail.com.
Neurocritical Care
|July 24, 2026
Summary
Rivaroxaban-related intracerebral hemorrhage (ICH) is linked to larger initial hematoma volumes compared to apixaban. Further studies are needed to confirm these findings in direct oral anticoagulant (DOAC) users.
Area of Science:
- Neurology
- Pharmacology
- Internal Medicine
Background:
- Direct oral anticoagulants (DOACs) are increasingly used for stroke prevention.
- Intracerebral hemorrhage (ICH) is a serious complication of anticoagulant therapy.
- The impact of specific DOAC agents on ICH hematoma volume is not well-established.
Purpose of the Study:
- To compare baseline hematoma volume in patients experiencing ICH while on apixaban versus rivaroxaban.
- To investigate potential differences in hematoma expansion and hospital mortality between the two DOAC groups.
Main Methods:
- Retrospective evaluation of 136 patients with spontaneous ICH on apixaban or rivaroxaban.
- Data collection included baseline hematoma volume, hematoma expansion, and hospital mortality.
- Multivariable linear regression analysis was used to identify independent predictors of hematoma volume.
Main Results:
- Rivaroxaban-associated ICH patients had significantly larger median baseline hematoma volumes (22.8 mL vs. 12.2 mL) compared to apixaban users.
- Rivaroxaban use was independently associated with larger baseline hematoma volume (P=0.009).
- No significant differences were observed in hematoma expansion or hospital mortality between the groups.
Conclusions:
- Rivaroxaban pretreatment is independently associated with larger baseline hematoma volume in patients with spontaneous ICH compared to apixaban.
- These findings suggest potential differences in the hemostatic effects of DOACs in the context of ICH.
- Larger cohort studies are warranted to validate these results.
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