FactorXI Inhibitors: A New Horizon in Anticoagulation Therapy.

Abstract

Anticoagulation therapy has undergone significant evolution, marked by the emergence of direct oral anticoagulants with distinct advantages. Despite these advancements, challenges persist in managing residual thrombotic and bleeding risks, particularly among vulnerable populations. The pursuit of alternative drugs has honed in on factorXI/XIa inhibitors. This comprehensive review delves into several key aspects regarding this new target: (i) the role of factorXI in the coagulation cascade; (ii) the genetic evidence and pathophysiologic rationale supporting factorXI inhibition as a therapeutic target; (iii) an exploration of the various types of factorXI/XIa inhibitors currently under investigation; (iv) potential applications of these medications, spanning thromboprophylaxis after orthopedic surgery, stroke prevention in atrial fibrillation, secondary prevention after acute coronary syndrome, non-cardioembolic stroke, thromboprophylaxis after foreign material implantation, end-stage renal disease, and patients with cancer; and (v) an overview of ongoing studies, recent findings, and the future trajectory of research into these drugs.