Antithrombotics and new interventions for venous thromboembolism: Exploring possibilities beyond factor IIa and...

Area of Science:

• Hematology
• Pharmacology
• Cardiovascular Medicine

Background:

• Direct oral anticoagulants (DOACs) and antithrombin agents are current standards for venous thromboembolism (VTE).
• Existing therapies have limitations in specific patient populations, including those with end-stage renal disease, mechanical heart valves, or antiphospholipid syndrome.
• Gaps in efficacy and safety necessitate the development of novel antithrombotic strategies.

Purpose of the Study:

• To explore emerging therapeutic targets and strategies for venous thromboembolism (VTE) treatment.
• To evaluate the potential of inhibiting coagulation factor XI (FXI) as a novel antithrombotic approach.
• To review advancements in anticoagulation beyond current direct oral anticoagulants.

Main Methods:

• Review of current literature on anticoagulation therapies for VTE.
• Investigation of novel targets such as coagulation factor XI (FXI), factor XII, polyphosphates, and kallikrein.
• Exploration of therapeutic modalities including antisense oligonucleotides, monoclonal antibodies, small-molecule inhibitors, and catheter-directed pharmacomechanical strategies.

Main Results:

• Inhibition of coagulation factor XI (FXI) is identified as a promising therapeutic target.
• Antisense oligonucleotides, monoclonal antibodies, and small-molecule inhibitors targeting FXI are under investigation.
• Catheter-directed, pharmacomechanical antithrombotic strategies are being developed for pulmonary embolism.

Conclusions:

• Emerging targets and novel agents, particularly those inhibiting FXI, offer potential to overcome limitations of current VTE treatments.
• Antisense oligonucleotides and antibody-based therapies show promise for prophylaxis and treatment.
• Advanced interventional strategies are being developed for high-risk pulmonary embolism, with large trials forthcoming.