The ideal goal of anticoagulant therapy is to attenuate thrombosis without compromising hemostasis. Although newer oral anticoagulants such as apixaban, rivaroxaban, and edoxaban are associated with less intracranial hemorrhage than vitamin K antagonists, bleeding remains their major side effect. Because of the decreased bleeding risk associated with targeting Factor XI, there has been a tremendous interest in developing agents to inhibit Factor XI activity or to attenuate Factor XI levels. This session will review the role of Factor XI in the development of thrombosis and review current approaches in inhibiting or decreasing Factor XI activity. Results from animal models and recent clinical trials of FXIa inhibition will be presented. As a potentially new anticoagulant, approaches to the diagnosis and management when associated with bleeding will be discussed. These approaches will be discussed in the context of bleeding patients with congenital and acquired Factor XI deficiency.
Professor of Pathology, Microbiology & Immunology,
Vanderbilt University Medical Center