The Emerging Role of Factor XIa Inhibition in Stroke Prevention

This episode, titled ‘The Emerging Role of Factor XIa Inhibition in Stroke Prevention,’ features neurology experts who discussed the following critical questions:

What was the clinical rationale for investigating factor XIa inhibitors and how do they target the pathophysiology of stroke?

What are the different factor XIa inhibitors under investigation, what are their respective routes of administration, and where are they in clinical development?

What are the strengths and limitations of oral vs. IV routes of administration?

Led by the moderator, the neurology experts examine the emerging science of Factor XIa inhibition as a potentially transformative approach to stroke prevention. Andrew Russman, Danison Emmerson, and David Rose discuss how targeting Factor XIa (or activated Factor XIa) may allow for the uncoupling of pathologic thrombus formation from normal hemostasis. This mechanism is supported by observations in patients with inherited Factor XI deficiencies, who show reduced rates of cardiovascular events without increased bleeding. The panel reviews the clinical development of investigational agents like asundexian and milvexian, highlighting the move into phase 3 trials and the relative benefits of oral versus intravenous administration. Ultimately, the experts emphasize that providing patients with effective, low-burden oral therapies remains a top priority for improving long-term adherence and secondary prevention outcomes.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, ‘The New Frontier of Antithrombotic Therapy: Safety and Efficacy of Factor XIa Inhibition’, panelists will continue their discussion on stroke and highlight the clinical data for the factor XIa inhibitors under investigation.