Emerging treatments
Factor XI inhibitors
The role of factor XI in the pathogenesis of VTE is an emergent area of research and there is promising evidence on the safety and efficacy of factor XI inhibitors in VTE prevention. In one trial comparing abelacimab (a monoclonal antibody that binds to the catalytic domain of factor XI preventing its activation) with enoxaparin in patients undergoing total knee arthroplasty, a single intravenous dose of abelacimab was effective for the prevention of venous thromboembolism and was associated with a low risk of bleeding.[142] Milvexian, an oral selective factor XIa inhibitor, was studied in a phase II trial. Patients undergoing knee arthroplasty were randomised to receive one of seven milvexian regimens or enoxaparin. Milvexian was found to decrease the risk of post-operative VTE in a dose-dependent manner, without increasing the bleeding risk.[143] Osocimab, another monoclonal antibody that binds to factor XIa, showed superiority compared with enoxaparin and met criteria for non-inferiority at lower doses.[144]
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