Oral anticoagulants, including warfarin and direct oral anticoagulants, are the standard of care for thrombosis prevention and treatment; however, concerns of bleeding often dictate treatment decisions. Inhibition of the intrinsic coagulation system via factor XIa may allow for selective inhibition of the coagulation cascade without significantly impacting hemostasis after injury. Asundexian is an oral small molecule factor XIa inhibitor that, via this novel mechanism, may prove to be a safe and effective option compared with available anticoagulants. Early clinical data for asundexian was promising as a safer alternative to current therapies and prompted further analysis in certain patient populations at increased thrombotic risk. Currently, studies are ongoing to evaluate the safety and efficacy in stroke prevention in atrial fibrillation and in patients following an acute noncardioembolic ischemic stroke or high-risk transient ischemic attack.
Keywords: FXIa; acute myocardial infarction; anticoagulant; antithrombotic; atrial fibrillation; bleeding; factor XIa inhibitor; oral anticoagulation; stroke; thrombosis.
Current oral anticoagulants have been shown to be effective for treating and preventing different clotting conditions. The disadvantage associated with these agents is an increased risk of bleeding; thus, there is a need for safer alternatives. Asundexian is a new anticoagulant that has been studied in patients after a stroke, patients with abnormal heart rhythms and patients after a heart attack in three completed clinical trials and two that are currently ongoing. Asundexian works by blocking factor XI, which is necessary for clot formation. Asundexian appears to be a promising option for preventing and treating thrombotic conditions while potentially limiting the risk of bleeding as a result of its distinct mechanism of action. The following summary explains how asundexian works and highlights the key studies showing the effects of this medication.