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Review
. 2025 Jul 8.
doi: 10.1007/s11239-025-03132-z. Online ahead of print.

Venous thromboembolism prevention and treatment with factor XI/XIa inhibitors: current status and future perspectives

Raul Del Toro-Mijares  1 , Mateo Porres-Aguilar  2 , Laurent Bertoletti  3 , Alfonso J Tafur  4   5 , Ilham Benzidia  6   7 , Guillermo Cueto-Robledo  8   9   10 , James D Douketis  11
Affiliations
Review

Venous thromboembolism prevention and treatment with factor XI/XIa inhibitors: current status and future perspectives

Raul Del Toro-Mijares et al. J Thromb Thrombolysis. .

Abstract

Current treatments for venous thromboembolism include warfarin, various heparins, and direct oral anticoagulants. While effective, there's ongoing research for safer alternatives, especially for high-risk patients (e.g., cancer, post-operative, and those with end-stage renal disease). Factor XI has been identified as crucial in abnormal thrombosis but less so in normal hemostasis, suggesting that inhibiting it could reduce thrombosis while also limiting bleeding risks. Recent phase 2 trials on factor XI inhibitors show promise for preventing venous thromboembolism in patients undergoing total knee arthroplasty, in cancer patients, and in patients with end-stage renal disease. Three key unmet needs include: need for large-scale phase 3 clinical trials, broader surgical applications and management of bleeding complications/reversal strategies. Further research on these aspects is essential, especially as factor XI inhibitors progress towards clinical use.

Keywords: Anticoagulation; Bleeding events; Factor XI; Factor XI inhibitors; Thromboprophylaxis; Venous thromboembolism.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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