Impact of code stroke on door-to-andexanet administration time for factor Xa inhibitor-associated intracranial hemorrhage: a single-center retrospective study

Background – Administration of andexanet alfa has shown to achieve hemostatic efficacy in factor Xa inhibitor (FXai)-associated intracranial hemorrhage (ICrH). Code stroke (CS), implemented through the visual task management application Task Calc. Stroke (TCS) facilitates timely reperfusion therapy for acute ischemic stroke. However, the association between TCS-based CS and in-hospital treatment time of andexanet for FXai-associated ICrH remains unknown. Methods – In this single-center retrospective study, patients with FXai-associated ICrH who received andexanet were enrolled from May 2022 to May 2025. TCS was activated via prehospital notification when patients presented with at least one of the clinical symptoms including face dropping, arm weakness, or speech difficulty with a time from onset or last known well of <24 h. Multivariable linear regression was performed to investigate the association between TCS-based CS and door-to-andexanet administration time. Results – Forty-two patients (22 men, median age 80 years) were included. The primary location of hemorrhage was intracerebral (n = 26), epidural/subdural (n = 8), or subarachnoid (n = 8). Among them, 17 (41.5%) were treated with TCS-based CS. The door-to-andexanet administration time was shorter in patients treated with TCS-based CS compared to those without (90 min vs. 132 min, p < 0.01). Multivariable analysis showed that TCS-based CS was associated with door-to-andexanet administration time (Exp [β] 0.58, 95% confidence interval 0.43–0.77) after adjustment with arrival during regular hours and baseline hematoma volume. Conclusion – TCS-based CS was associated with a shorter door-to-andexanet administration time for FXai-associated ICrH. The outcome benefit from improved treatment times warrants further investigation.