SynthesisJournal of thrombosis and thrombolysis2025
Safety of factor XI inhibitors compared to factor X inhibitors in atrial fibrillation: a systematic review and meta-analysis.
Synthesis in Journal of thrombosis and thrombolysis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Factor XI(a) Inhibition in Secondary Stroke Prevention: On the Cusp of a New Anticoagulation Paradigm.ACS pharmacology & translational science · 2026Article
- Factor XI Inhibition for Ischemic Stroke Secondary Prevention: Pharmacology, Clinical Evidence, and Future Directions.Journal of clinical pharmacology · 2026Review
- Anticoagulation Stewardship in the Era of Practice-Changing Evidence: A Narrative Review of Recent Trials and Their Bedside Translation.Journal of clinical medicine · 2026Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Atrial fibrillation (AF) increases the risk of ischemic stroke (IS) and systemic embolism, necessitating thromboprophylaxis with direct oral anticoagulants (DOAC), which increase bleeding. Drugs that inhibit factor XI (FXI) have been developed to provide thromboprophylaxis with lower bleeding risk. We performed a systematic review and meta-analysis of randomised controlled trials comparing FXI inhibitors versus DOAC in patients with AF, reporting primary outcomes of International Society of Thrombosis and Haemostasis (ISTH) major bleeding or clinically relevant non-major bleeding (CRNMB), and exploratory outcomes of ischaemic stroke (IS), intracranial hemorrhage (ICH) and death. Three trials were identified. The PACIFIC-AF (Phase 2) and OCEANIC-AF (Phase 3) trials compared asundexian, an oral, small-molecule FXIa inhibitor, with apixaban. AZALEA-TIMI 71 (Phase 2) compared abelacimab, a subcutaneous monoclonal antibody against FXI/FXIa, with rivaroxaban. FXI inhibitors reduced the composite of major bleeding or CRNMB (pooled-OR 0.39, 95%CI 0.30–0.50, p = 0.0005), major bleeding (OR 0.30, 95%CI 0.22–0.41, p = 0.004) and CRNMB (pooled-OR 0.44, 95% CI 0.36–0.55, p = 0.0004) compared to DOAC. Effects were consistent across sex, clinical risk factors and concomitant antiplatelet therapy. Exploratory analyses showed FXI inhibitor use was associated with greater risk of IS (OR 3.37, 95%CI 2.18–5.19, p = 0.001), similar rate of ICH and lower all-cause mortality (OR 0.82, 95%CI 0.71–0.94, p = 0.02) than DOAC. Compared to DOAC, FXI inhibitors significantly reduced major bleeding or CRNMB. Exploratory analyses indicate similar risk of ICH, but possible increased IS risk with FXI inhibitors compared to DOAC. Results from ongoing trials will help determine the relative usefulness of FXI inhibitors in patients with AF.
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