Factor XI/XIa inhibitors are an emerging class of anticoagulants that may prevent pathologic thrombi while preserving hemostasis, though larger clinical trials are needed to establish their clinical role.
Factor XI/XIa inhibitors represent a promising emerging class of anticoagulants that may uncouple thrombosis from hemostasis, potentially reducing bleeding risk compared to current therapies.
Factor XI/XIa represents a potential target for improved precision in anticoagulation, because it is involved primarily in thrombus formation and plays a much smaller role in clotting and hemostasis. This suggests that inhibition of FXI/XIa could prevent pathologic thrombi from forming, but largely preserve a patient’s ability to clot in response to bleeding/trauma. This theory is supported by observational data showing that patients with congenital FXI deficiency have lower rates of embolic events without an increase in spontaneous bleeding. Small Phase 2 trials of FXI/XIa inhibitors have offered encouraging data with regards to bleeding and safety, and evidence of efficacy for prevention of venous thromboembolism. However, larger clinical trials across multiple patient groups are needed for this emerging class of anticoagulants in order to understand their possible role in clinical use. Here we review the potential clinical indications for FXI/XIa inhibitors, data available to date, and consider future trials.
Harrington et al. (2023) conducted a review in Thrombosis. Factor XI/XIa inhibitors was evaluated. Factor XI/XIa inhibitors are an emerging class of anticoagulants that may prevent pathologic thrombi while preserving hemostasis, though larger clinical trials are needed to establish their clinical role.