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Non-linear association of coagulation factor XI with mortality

Katsiaryna Prystupa1, Martin Heni2, Sebastian Hörber3

  • 1Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, Neuherberg, Germany.

Med (New York, N.Y.)
|December 27, 2025
PubMed

Insights

Coagulation factor XI (FXI) activity shows a U-shaped link to mortality in coronary artery disease (CAD) patients. Higher FXI activity increases mortality risk in CAD, unlike in non-CAD individuals.

Area of Science:

  • Cardiovascular Medicine
  • Hemostasis Research
  • Clinical Trials

Background:

  • Coagulation factor XI (FXI) plays a role in thrombosis and myocardial function.
  • Understanding FXI's impact on mortality is vital for treating coronary artery disease (CAD).

Purpose of the Study:

  • To investigate the association between coagulation factor XI (FXI) activity and mortality risk.
  • To explore how CAD and NT-proBNP levels modify this relationship.

Main Methods:

  • Analysis of 3,170 participants undergoing coronary angiography, with 67% diagnosed with CAD.
  • Median follow-up of 14.5 years, assessing mortality risk using Cox models.
  • Exploration of interactions between FXI activity, NT-proBNP, and CAD status.

Main Results:

  • A U-shaped association between FXI activity and mortality was observed (p=0.027), with lowest risk at 115.6% FXI activity.
  • This U-shaped pattern persisted in patients without CAD.
  • In CAD patients, higher FXI activity showed a linear correlation with increased mortality (p-interaction < 0.0001), significantly modified by NT-proBNP levels.

Conclusions:

  • FXI activity has a dual role in hemostasis with implications for drug development.
  • Treatment strategies targeting FXI may require personalization based on cardiovascular conditions.
  • Future FXI inhibitor studies must consider modulating factors like CAD and NT-proBNP for optimized therapies.
Abstract

Keywords:
FXI activityLURIC studyNT-proBNPcardiovascular diseasecoagulation factor XIcoronary artery diseaseheart failurehemostasismortality risknon-linear associationspersonalized treatmentpharmacological interventionstranslation to patients

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