Factor Xa Inhibition, A New Strategy for Prevention of Adverse Cardiac Remodeling in Early Stages?

Figure 1. Conceptual Diagram of the Beneficial Effects of Low-Dose FXa Inhibition Conceptual diagram of the beneficial effects of low-dose factor Xa (FXa) inhibition (blue), which may result in reduction in major adverse cardiovascular events (MACE) by attenuation of maladaptive cardiac fibrosis, hypertrophy, inflammation, and left ventricular (LV) remodeling in early phenotypes such as patients with coronary artery disease (CAD), acute coronary syndrome (ACS) without or with mild to moderate heart failure (HF) (A), but not in advanced phenotypes of heart failure with reduced ejection fraction (HFrEF) and New York Heart Association (NYHA) functional classes III and IV HF (B). In advanced HF phenotypes, rather than a low dose, an anticoagulant dose of FXa inhibition (orange) may be important to reduce venous thromboembolic events (VTE), thrombotic events, and stroke, which awaits validation by large-scale clinical trials. Heart clipart images adapted from Servier Medical under a Creative Commons Attribution 3.0 Unsupported License (https://creativecommons.org/licenses/by/3.0/).