Unmet Needs in Atrial Fibrillation (AF) and the Promise of Factor XI as a New Therapeutic Target

This presentation explores the persistent challenges in managing atrial fibrillation (AF) — particularly the limitations of current oral anticoagulants. While therapies like warfarin and DOACs have been transformative, concerns about bleeding, dosing complexity, and adherence continue to impact real-world effectiveness.

Factor XI (FXI) inhibitors are a promising new frontier in anticoagulation. Early data suggest these agents may offer stroke and thromboembolic protection with significantly reduced bleeding risk — a potential paradigm shift in AF treatment.

https://pub-4144d0fe0732486b98e4bba3bec60e16.r2.dev/Factor%20XI%20Research%20Slides.pdf

High-Level Learnings:

• AF is a leading cause of stroke with rising global prevalence — often underdiagnosed until a serious event occurs.

• Despite guideline recommendations, oral anticoagulants are under-prescribed or under-dosed in a substantial portion of high-risk AF patients.

• Physician concerns (bleeding risk, poly-pharmacy) and patient concerns (fear of bruising, lifestyle changes, pill burden) contribute to non-adherence.

• Current therapies, including DOACs and VKAs, face pharmacokinetic and safety challenges that complicate consistent protection.

• FXI inhibitors may overcome many limitations by targeting a different point in the coagulation cascade, potentially reducing both major and minor bleeding.

• Multiple phase 2 and 3 trials are underway to evaluate efficacy and safety across surgical, high-risk, and AF populations.

Meet Our Contributors:

This content is brought to you through the collaborative efforts of our Vasculearn Network, Medical Advisory Board, and Executive Review Team:

Medical Advisory Board:

• Tara Lech, PharmD

• Aviva Schwartz, MA

• Behnood Bikdeli, MD, MS

• Heather Johnson, MD

• Margo Minissian, PhD, ACNP

• JoMarie Monzon, FNP-BC, MSN

• Scott Woller, MD

• LaVon Woodard (Patient Advocate)

Executive Board & Reviewers:

• Christian Ruff, MD, MPH

• Jean Connors, MD

• John Fanikos, RPh, MBA

• Charles Pollack, MD

• Alex C. Spyropoulos, MD

• Ruth Morrison, RN

• Joelle Hochman, RRT

• Jelena Spyropoulos, PhD

• Nathan T. Connell, MD, MPH

• Courtney Anderson

• Kathryn Mikkelsen, MBA

Explore the deck, share your clinical perspectives, and join the conversation as we collectively work to close the gap in anticoagulation care.