The factor XIa inhibitor asundexian, did not cause excess bleeding when given with antiplatelets in a pair of large phase 2, dose-ranging trials in different secondary-prevention settings. ESCCongress
, in patients with AF. In that trial, asundexian supressed factor XIa activity about as thoroughly as it did in PACIFIC-AMI.it is launching a phase 3 asundexian program that is expected to involve tens of thousands of patients, starting with trials called OCEANIC-AF and OCEANIC-STROKE.
In PACIFIC-AMI,"there was no clear signal toward either efficacy or bleeding," observed Michelle L. O'Donoghue, MD, MPH, Brigham and Women's Hospital, Boston, the invited discussant, after the presentation. Still, said Alexander,"of the doses we studied in PACIFIC-AMI, the 50 mg dose looks very attractive. It doesn't seem to cause bleeding, at least not in a modest-sized phase 2 trial. And it almost completely inhibits factor XI, so taking that forward would be interesting."
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