{"id":"daf86bf00507","type":"article","url":"https://hartvaat.nl/2026/02/01/factor-xi-xia-remmers-bij-atriumfibrilleren-dosisrespons-werkzaamheid-en-veiligh/","title":"Factor XI/XIa-remmers bij atriumfibrilleren: dosisrespons, werkzaamheid en veiligheid","title_en":"Dose-Response Efficacy and Safety of Factor XI/XIa Inhibitors in Atrial Fibrillation; a Systematic Review and Meta-Analysis With Subgroup Exploration and Trial Sequential Validation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["abelacimab","apixaban","atriale-cardiomyopathie","bloeddrukbehandeling","edoxaban","esc-2026","rivaroxaban"],"journal":"Clinical cardiology","doi":"10.1002/clc.70263","source_url":"https://doi.org/10.1002/clc.70263","authors":["Muhammad Aqib Faizan","Tooba Rehman","Mrunalini Dandamudi","Jaivardhan A Menon","Victoria Zecchin Ferrara","Zeyad Kholeif","Alina Tanvir","Fatima Saeed","Jibran Ikram","Moiuz Chaudhri","Carlos Espiche","Main Muhammad Salman Aslam","Zainab Humayun","Ahmad Mustafa Khalid","Saad Ahmad Waqas","Raheel Ahmad","Luis Cerna"],"significance":5,"published":"2026-02-01","source_date":"2026-02-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"esc-2026","summary_en":"A systematic review and meta-analysis with trial sequential validation evaluated the dose-response efficacy and safety of factor XI/XIa inhibitors compared to direct oral anticoagulants in atrial fibrillation. These emerging agents may reduce bleeding complications while providing adequate stroke prevention.","created":"2026-07-03T10:25:14Z","updated":"2026-08-10T11:07:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Factor XI/XIa-remmers zijn opkomende antistollingsmiddelen die bloedingscomplicaties bij AF-patiënten mogelijk verminderen. Deze meta-analyse evalueerde hun werkzaamheid en veiligheid vergeleken met DOAC's en onderzocht dosisoptimalisatie met trial-sequentiële validatie.","abstract_original":"BACKGROUND: Factor XI/XIa inhibitors are emerging anticoagulants with potential to reduce bleeding complications in atrial fibrillation (AF) patients. This meta-analysis evaluated their efficacy and safety compared to direct oral anticoagulants (DOACs) and explored dose optimization. METHODS: A systematic search of PubMed, Cochrane, and Embase was conducted through March 2025 following PRISMA guidelines. Randomized controlled trials (RCTs) comparing Factor XI/XIa inhibitors with DOACs in AF patients were included. Outcomes assessed were major bleeding, stroke, systemic embolism, all-cause and cardiovascular mortality and serious adverse events. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a Mantel-Haenszel random-effects model. Heterogeneity was evaluated with the I² statistic, and evidence certainty assessed by the GRADE approach. Trial Sequential Analysis (TSA) was performed. RESULTS: Three RCTs including 16,772 patients (mean age 73 years, CHA₂DS₂-VASc 3.9-5) were analyzed. Factor XI/XIa inhibitors significantly reduced major bleeding (RR: 0.41, 95% CI: 0.36-0.46, I² = 0%) compared to DOACs. However, stroke risk was increased (RR: 3.42, 95% CI: 2.62-4.46), particularly with asundexian 50 mg (RR: 4.02). No significant differences were observed in all-cause mortality (RR: 0.82) or cardiovascular death (RR: 1.05). Systemic embolism risk was higher (RR: 4.26), while serious adverse events were comparable (RR: 0.95). TSA indicated encouraging safety outcomes but highlighted the need for further large-scale studies. CONCLUSION: Factor XI/XIa inhibitors lower major bleeding risk in AF patients but increase stroke and systemic embolism rates without impacting mortality."}