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January 14, 2020

How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?

Author Affiliations
  • 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA. 2020;323(2):121-122. doi:10.1001/jama.2019.20783

The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders.1 These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% relative risk reduction in intracranial hemorrhage.2 Nevertheless, bleeding with the direct oral anticoagulants remains a clinically significant issue, particularly in vulnerable patient populations, such as older patients and those with renal dysfunction.