Key result
Milvexian added to antiplatelet therapy after acute coronary syndrome did not reduce cardiovascular death, MI, or ischemic stroke in the early-terminated LIBREXIA-ACS trial.
Why the study?
Does milvexian added to antiplatelet therapy reduce cardiovascular death, myocardial infarction, or ischemic stroke in patients after acute coronary syndrome?
Does milvexian added to antiplatelet therapy reduce cardiovascular death, myocardial infarction, or ischemic stroke in patients after acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
Following the early futility termination of LIBREXIA-ACS where milvexian failed to reduce ischemic events after acute coronary syndrome, optimizing factor XIa inhibitor selection, dosing, and target clinical indications remains necessary.
LIBREXIA-ACS was terminated early for futility. Milvexian, added to antiplatelet therapy after acute coronary syndrome, did not reduce cardiovascular death, myocardial infarction, or ischemic stroke, but did not increase intracranial or fatal bleeding. The contribution of factor XI to arterial thrombosis may vary across clinical indications, while the specific factor XIa inhibitor, dose, and patient selection remain to be optimized.
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Palaiodimou et al. (2026) conducted an editorial in Acute coronary syndrome. Milvexian vs. Antiplatelet therapy alone was evaluated on Cardiovascular death, myocardial infarction, or ischemic stroke. Milvexian added to antiplatelet therapy after acute coronary syndrome did not reduce cardiovascular death, MI, or ischemic stroke in the early-terminated LIBREXIA-ACS trial.
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