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Factor XI Inhibition: Adult Evidence and Paediatric Considerations

Susanne Holzhauer1, Christoph Male2

  • 1Charité - Universitätsmedizin Berlin, Department of Paediatric Haematology and Oncology, BE, Germany, Berlin.

Hamostaseologie
|August 7, 2026
PubMed

Insights

Factor XI (FXI) inhibition shows promise for anticoagulation with less bleeding risk. This review explores its potential use in children, examining current evidence from preclinical and adult studies.

Area of Science:

  • Pharmacology and Therapeutics
  • Hematology
  • Pediatric Medicine

Background:

  • Factor XI (FXI) inhibition is a novel anticoagulation strategy with potential for reduced bleeding risk.
  • Current research primarily focuses on adult populations, leaving pediatric applications largely unexplored.
  • Limited evidence exists to guide the use of FXI inhibitors in children.

Purpose of the Study:

  • To systematically review preclinical and adult studies on FXI inhibition (FXIa).
  • To assess the implications of existing FXIa evidence for pediatric application.
  • To inform future pediatric treatment strategies for anticoagulation.

Main Methods:

  • Systematic literature review of preclinical studies on FXIa.
  • Systematic literature review of adult clinical studies on FXIa.
  • Analysis of evidence translation from adult to pediatric populations.

Main Results:

  • Preclinical and adult studies demonstrate FXIa's efficacy in thrombosis prevention.
  • Adult studies suggest a potentially favorable bleeding profile compared to other anticoagulants.
  • Significant gaps in knowledge exist regarding FXIa pharmacokinetics, pharmacodynamics, and safety in pediatric patients.

Conclusions:

  • FXI inhibition holds promise as a safer anticoagulation method for children.
  • Further research is critically needed to establish optimal pediatric dosing, efficacy, and safety.
  • Translating adult FXIa data to pediatric use requires careful consideration of developmental differences.

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