FXI Inhibitors: A New Frontier in Anticoagulation Therapy-FXI Inhibitors: A New Frontier in Anticoagulation Therapy

Video Transcription

Video Summary

The webinar introduced factor XI inhibitors as a new class of anticoagulants designed to reduce thrombosis while preserving normal hemostasis. Gabe Fontaine explained how these agents differ from current anticoagulants by targeting factor XI/XIa earlier in the coagulation cascade, with the goal of lowering both arterial and venous clotting without significantly increasing bleeding. He also reviewed why this target is promising, citing observational data showing that people with natural factor XI deficiency have fewer ischemic strokes, myocardial infarctions, and venous thromboembolic events, with little increase in major bleeding.<br /><br />Dr. Roxana Dumitru reviewed the main clinical evidence across several settings. In atrial fibrillation, asundexian failed to match apixaban for stroke prevention in OCEANIC-AF, while abelacimab reduced bleeding versus rivaroxaban in a phase 2 study. In secondary stroke prevention, asundexian showed benefit in OCEANIC-Stroke without increasing bleeding, and milvexian also showed a favorable safety profile in phase 2. In acute MI/ACS, milvexian did not improve outcomes versus placebo. In VTE prophylaxis after knee arthroplasty, factor XI inhibitors generally matched or outperformed enoxaparin with similar or lower bleeding. Data in cancer-associated thrombosis and end-stage kidney disease remain limited.<br /><br />Dr. Ashkan Chouamanash discussed perioperative and bleeding management. Guidance is largely expert opinion-based and depends on drug class: oral small molecules may only need brief interruption, while antibodies and antisense oligonucleotides may require much longer or may not be feasible to stop. Tranexamic acid is first-line for bleeding or procedures; factor XI concentrate may help with antisense oligonucleotides, while recombinant factor VIIa, PCC, or APCC may be considered for antibodies or small molecules.

Meta Tag

Concept Factor XI

Concept Factor XIa

Concept Thrombosis

Concept Hemostasis

Concept Anticoagulant

Keywords

factor XI inhibitors

anticoagulants

thrombosis prevention

hemostasis

atrial fibrillation

stroke prevention

venous thromboembolism

bleeding risk

clinical trials

perioperative management

Factor XI

Factor XIa

Thrombosis

Hemostasis

Anticoagulant

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