Why the study?
Bleeding complications constrain conventional antithrombotic therapies for secondary stroke prevention, prompting evaluation of Factor XI as a hemostasis-sparing anticoagulation target.
Do Factor XI(a) inhibitors reduce recurrent ischemic stroke without increasing major bleeding in patients requiring secondary stroke prevention?
Design
Review
Key result
Asundexian 50 mg once daily added to antiplatelet therapy reduced recurrent ischemic stroke by 26% (HR 0.74; 95% CI 0.65-0.84) among patients with noncardioembolic stroke.
Authors
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May support FXIa inhibitors for safer secondary stroke prevention; leaves open confirmation in additional randomized trials.
Do Factor XI(a) inhibitors reduce recurrent ischemic stroke without increasing major bleeding in patients requiring secondary stroke prevention?
Hazard Ratio: 0.74 (95% CI 0.65–0.84)
Factor XI(a) inhibitors, particularly asundexian, show promise for secondary prevention of noncardioembolic ischemic stroke by reducing recurrence without increasing major bleeding, though their efficacy is highly dependent on the clinical context.
Rami A. Al‐Horani (2026) conducted a review in Ischemic stroke. Factor XI(a) inhibitors was evaluated on recurrent ischemic stroke (HR 0.74, 95% CI 0.65-0.84). Asundexian 50 mg once daily added to antiplatelet therapy reduced recurrent ischemic stroke by 26% (HR 0.74; 95% CI 0.65-0.84) among patients with noncardioembolic stroke.