Driving Progress in Cardiology: Exploring the Role of FXI in Acute Coronary Syndromes & Beyond-video

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Video Summary

At SC&I 2025, experts Roxana Moran and Mike Gibson discussed advancements in cardiology focusing on factor XI inhibition as a promising therapeutic approach for acute coronary syndromes (ACS). Traditional anticoagulants effectively reduce thrombotic events but increase bleeding risk, complicating patient management. Factor XI deficiency, observed genetically in some populations, correlates with fewer thrombotic events and less bleeding, making it a compelling target to uncouple thrombosis reduction from bleeding risk.<br /><br />They highlighted the limitations of current dual antiplatelet therapy (DAPT) durations, noting the challenge of balancing ischemic protection versus bleeding risk, especially in high bleeding risk patients. Data shows many clinicians default to longer DAPT despite evidence favoring shorter courses. Factor XI inhibitors like milvexian and asundexian—small molecules targeting intrinsic coagulation pathway—are undergoing large trials in ACS, atrial fibrillation (AF), and post-stroke settings to confirm efficacy and safety.<br /><br />The intrinsic pathway involving factor XI contributes to pathological thrombus formation without impairing normal hemostasis, offering potential to prevent ischemic events while minimizing bleeding. Early studies and Mendelian randomization support this approach, though challenges remain in dosing and patient selection, as shown by mixed trial results.<br /><br />Overall, the discussion underscored the need for innovative therapies targeting factor XI to improve outcomes beyond current standards, aiming for safer long-term anticoagulation that reduces major adverse cardiovascular events without increasing bleeding complications.

Keywords

Factor XI inhibition

acute coronary syndromes

anticoagulants

bleeding risk

dual antiplatelet therapy

milvexian

asundexian

intrinsic coagulation pathway

cardiovascular therapeutics