In the recent AXIOMATIC-TKR trial, milvexian demonstrated promising results in preventing venous thrombosis after knee surgery, significantly outperforming the traditional anticoagulant enoxaparin.

Similarly, the ANT-005 trial found that abelacimab was more effective than enoxaparin in preventing venous thromboembolism post-knee surgery, suggesting further exploration of its applications.

Despite the development of new anti-factor XI anticoagulants, uncertainty looms over their future use following the phase 3 OCEANIC-AF trial's termination due to asundexian's ineffectiveness in preventing ischemic risk.

At the 2025 European Days of the French Society of Cardiology in Paris, experts discussed the potential applications of factor XI inhibitors in various thromboembolic risk scenarios.

Asundexian's short half-life and once-daily dosing may contribute to an increased thrombotic risk, contrasting with milvexian's more frequent dosing and higher inhibition rates.

Milvexian is currently being evaluated in several ongoing phase 3 trials aimed at preventing ischemic events across various patient populations, reflecting continued interest in its efficacy despite earlier inconclusive results.

Clinical doubts remain regarding the role of factor XI inhibitors, which are expected to prevent strokes and thrombotic events without raising bleeding risks.

The ongoing OCEANIC-STROKE trial is assessing asundexian's efficacy in preventing thromboembolic risk post-stroke, with no negative signals reported thus far.

The phase 2b AZALEA-TIMI trial revealed that abelacimab significantly reduced major bleeding events while maintaining a low stroke rate, although further studies are needed for confirmation.

Antibody-based inhibitors like abelacimab are being investigated for their potential efficacy, requiring only monthly dosing and showing promising results in preliminary trials.

Previous trials have indicated that some anti-factor XI drugs, such as FXI-ASO and fesomersen, effectively reduce venous thrombosis compared to traditional treatments.

Isabelle Gouin-Thibault, PhD, emphasized the potential uses of these anticoagulants in high-risk patients, including those with renal disease or cancer, as well as during procedures like angioplasty.