Factor XI Inhibition to Uncouple Thrombosis From Hemostasis: JACC Review Topic of the Week.

Hemostasis and thrombosis are believed to be so intricately linked that any strategies that reduce thrombosis will have an inevitable impact on hemostasis. Consequently, bleeding is viewed as an unavoidable side effect of anticoagulant therapy. Emerging evidence suggests that factor XI is important for thrombosis but has a minor role in hemostasis. This information raises the possibility that anticoagulants that target factor XI will be safer than currently available agents. The authors provide a visual representation of the coagulation pathways that distinguishes between the steps involved in thrombosis and hemostasis to explain why factor XI inhibitors may serve as hemostasis-sparing anticoagulants. A safer class of anticoagulants would provide opportunities for treatment of a wider range of patients, including those at high risk for bleeding. Ongoing clinical studies will determine the extent to which factor XI inhibitors attenuate thrombosis without disruption of hemostasis.

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Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures The development of this paper was funded by Anthos Therapeutics. Drs Gailani and Weitz had complete editorial control of the manuscript with Anthos providing project management support. Dr Hsu was a contractor to Anthos Therapeutics during the development of this paper. Dr Hutt has received consulting fees from Anthos Therapeutics. Dr Bloomfield is an employee of Anthos Therapeutics. Drs Gailani and Weitz have received consulting fees and honoraria from Anthos Therapeutics, Bayer, Bristol Myers Squibb, Ionis, and Janssen. Dr. Weitz holds the Canada Research Chair (Tier I) in Thrombosis and the Heart and Stroke Foundation J. F. Mustard Chair in Cardiovascular Research at McMaster University.