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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Use of factor XI/XIa inhibitors in patients with atrial fibrillation: Current progress and future prospects

Yue Fan1, Xi Chen2, Yueyun Jiang1

  • 1Phase Ⅰ Clinical Trial Centre, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China; Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.

Ageing Research Reviews
|September 11, 2025
PubMed

Insights

New anticoagulants targeting Factor XI/XIa (FXI/XIa) show promise for stroke prevention in elderly atrial fibrillation (AF) patients. These agents may offer effective thrombosis reduction with fewer bleeding risks than traditional therapies.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Stroke prevention is crucial for elderly patients with atrial fibrillation (AF).
  • Current anticoagulants have limitations, including bleeding complications, especially in aging populations.
  • Novel anticoagulation strategies are needed to improve safety and efficacy.

Purpose of the Study:

  • To review the potential of Factor XI/XIa (FXI/XIa) inhibitors as a novel anticoagulant approach for AF.
  • To discuss the rationale, pharmacology, and clinical evidence for FXI/XIa inhibitors.
  • To assess the application prospects of FXI/XIa inhibitors in elderly AF patients.

Main Methods:

  • Literature review of FXI/XIa inhibitors for AF anticoagulation.
  • Analysis of pharmacological properties and clinical trial data.
  • Discussion of ongoing research and future directions.

Main Results:

  • FXI/XIa inhibitors selectively target the intrinsic coagulation pathway, attenuating thrombin generation without impairing hemostasis.
  • Clinical trials indicate favorable safety profiles with reduced bleeding risks compared to traditional anticoagulants.
  • Preliminary efficacy in preventing thromboembolic events has been observed, with ongoing trials.

Conclusions:

  • FXI/XIa inhibitors represent a promising novel anticoagulant strategy for AF.
  • These agents have the potential to improve anticoagulation therapy by decoupling thrombosis prevention from bleeding complications in elderly AF patients.
  • Further long-term safety and efficacy evaluations are ongoing.

Keywords:
Atrial fibrillationBleeding risk reductionClinical trialsFactor XI/XIa inhibitorsThrombosis prevention

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