Do Factor XIa inhibitors reduce stroke and bleeding compared to Factor Xa inhibitors in patients with atrial fibrillation?
In patients with atrial fibrillation, Factor XIa inhibitors significantly reduce bleeding and hemorrhagic stroke compared to Factor Xa inhibitors, but are associated with a higher risk of ischemic stroke and MACE.
Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common chronic liver disorder linked to metabolic syndrome traits and insulin resistance, often progressing to fibrosis.While lifestyle modification remains central to management, pharmacologic therapies such as Sodium Glucose Co-transporter inhibitors (SGLT2i) have shown promising effects.However, the cardiovascular effects of SGLT2i in MASLD remains unexplored.Methods: We systematically searched PubMed, Scopus, and Cochrane databases from inception to December 19, 2025, for studies evaluating the cardiovascular effects of SGLT2i on blood pressure and lipid parameters in patients with MASLD.Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.Results: SGLT2i therapy significantly reduced systolic blood pressure (MD: -3.29 mmHg; 95% CI: -4.20 to -2.39; p<0.00001) and diastolic blood pressure (MD: -2.45 mmHg; 95% CI: -3.72 to -1.19; p=0.0001).SGLT2i was also associated with a significant reduction in LDL cholesterol (SMD: -0.27; 95% CI: -0.43 to -0.10; p=0.001).SGLT2i also reduced liver enzymes, including ALT (SMD: -0.42; 95% CI: -0.77 to -0.07; p=0.02) and AST (SMD: -0.57; 95% CI: -0.92 to -0.21; p=0.002).Glycemic parameters improved, with reductions in HbA1c (SMD: -0.32; 95% CI: -0.53 to -0.12; p=0.002) and fasting glucose (SMD: -0.38; 95% CI: -0.59 to -0.16; p=0.0006).Conclusions: SGLT2i therapy in patients with MASLD is associated with significant metabolic and cardiovascular benefits.However, further large-scale clinical trials should be conducted.
Jha et al. (Wed,) studied this question.