Trials found less major bleeding but more stroke with Factor XI/XIa inhibitors
In atrial fibrillation trials, Factor XI/XIa inhibitors had lower major bleeding risk and higher stroke risk than direct oral anticoagulants.
Based on the published abstract. The full paper may contain additional methods, results and limitations.
The 30-second takeaway
The pooled trials found lower major bleeding risk but higher stroke risk with Factor XI/XIa inhibitors than with direct oral anticoagulants. Systemic embolism risk was also higher; mortality differences were not statistically significant. Lower bleeding risk alone therefore cannot establish a better overall treatment strategy for people with atrial fibrillation.
The abstract omits follow-up durations and absolute event rates. These pooled results do not establish the best individual drug or dose.
What researchers found
Major bleeding risk ratio
For Factor XI/XIa inhibitors; 95% confidence interval: 0.36–0.46 times that risk. Follow-up duration not reported.
Stroke risk ratio
For Factor XI/XIa inhibitors; 95% confidence interval: 2.62–4.46 times that risk. Follow-up duration not reported.
What the ratios mean
Risk ratios compare event risks between treatments; they are not absolute probabilities. Confidence intervals describe uncertainty in those comparisons. The abstract does not report how many people experienced each outcome.
Other outcomes remain uncertain
All-cause and cardiovascular mortality showed no significant differences. Serious adverse events were described as comparable, without an uncertainty interval. Neither statement establishes equal survival or safety across treatments.
The original publication
Dose-Response Efficacy and Safety of Factor XI/XIa Inhibitors in Atrial Fibrillation; a Systematic Review and Meta-Analysis With Subgroup Exploration and Trial Sequential Validation.
Faizan MA, Rehman T, Dandamudi M et al.
Clin Cardiol · 2026
- PubMed ID
- 41677103
- Record checked
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