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Factor XI inhibitors in patients with cardiovascular disease and a high risk of bleeding: a cautionary tale

Nature Reviews Cardiology volume 20, pages 511–512 (2023)Cite this article

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Factor XIa inhibitors are being tested in clinical trials, with the assumption that these agents are as effective as direct oral anticoagulants but cause fewer bleeding events. Findings from phase II trials of direct inhibitors of factor XIa for the prevention of first-ever and recurrent ischaemic stroke or recurrent major coronary artery events suggest fewer bleeding events but with uncertainty about efficacy.

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Fig. 1: Coagulation cascade and current and future clinical applications of factor XI inhibitors in cardiovascular disease.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden

    Bruna Gigante

  2. Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden

    Bruna Gigante

  3. Thrombosis Expert Center, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands

    Hugo ten Cate

  4. Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands

    Hugo ten Cate

  5. CARIM School for Cardiovascular Research, Maastricht, Netherlands

    Hugo ten Cate

  6. Center for Thrombosis and Hemostasis, Gutenberg University Medical Center, Mainz, Germany

    Hugo ten Cate

Authors
  1. Bruna Gigante
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  2. Hugo ten Cate
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Corresponding author

Correspondence to Hugo ten Cate.

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Competing interests

H.t.C. has received consultancy fees from Aleveron, AstraZeneca, Galapagos and Novostia and research funding from Bayer; all revenues are deposited at the CARIM Institute and labelled for research. H.t.C. is stockholder of Coagulation Profile, a spinoff diagnostic company of Maastricht University. B.G. declares no competing interests.

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AXIOMATIC-SSP study: https://www.phri.ca/research/axiomatic-ssp/

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Gigante, B., ten Cate, H. Factor XI inhibitors in patients with cardiovascular disease and a high risk of bleeding: a cautionary tale. Nat Rev Cardiol 20, 511–512 (2023). https://doi.org/10.1038/s41569-023-00872-4

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