Deans' stroke musings: ESOC 2023 | FXIa inhibition for secondary stroke prevention: current evidence

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, September 23, 2023

ESOC 2023 | FXIa inhibition for secondary stroke prevention: current evidence

What does your doctor think?

ESOC 2023 | FXIa inhibition for secondary stroke prevention: current evidence

Ashkan Shoamanesh, MD, McMaster University, Hamilton, Canada, discusses the evidence supporting Factor XIa (FXIa) inhibition for secondary stroke prevention. FXIa has a role in thrombus formation and propagation, but a smaller role in hemostasis. Therefore, it has been proposed that inhibition of FXIa could stop thromboembolic events by blocking clot generation, without increasing the number of clinically relevant bleeds. Clinical evidence supporting this hypothesis includes observations of lower risk of ischemic stroke and venous thromboembolism (VTE) in populations with deficiencies in FXIa (e.g. hemophilia C), compared to the general population. Evidence from Mendelian randomization analyses also shows that increased levels of FXIa are linked to VTE and ischemic stroke, but not major bleeding. There are currently several Phase II clinical trials investigating FXIa inhibition, which are demonstrating that FXIa can stop thrombus propagation and formation without affecting bleeding. In patients undergoing knee surgery, milvexian, a first-in-class oral inhibitor of FXIa, has been shown to stop thromboembolism more effectively than enoxaparin, while in patients with atrial fibrillation, the use of asundexian has been associated with less bleeding than the current widely used oral anticoagulant apixaban. For secondary stroke prevention two Phase II clinical trials have been conducted; the PACIFIC-STROKE trial (NCT04304508) and the AXIOMATIC-SSP trial (NCT03766581), investigating the FXIa inhibitors asundexian and milvexian respectively, which have shown similar positive results to previous studies. Currently, Dr Shoamanesh’s group are conducting the OCEANIC-STROKE trial (NCT05686070), which is being undertaken to investigate the effect of 50 mg of asundexian, taken daily, in patients with non-cardioembolic ischemic stroke who are enriched for baseline atherosclerotic disease. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.

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