In this introductory session, Prof Carolyn Lam and the expert faculty set the stage for a deep dive into the evolving field of thrombosis management, highlighting ongoing challenges in ACS, stroke and atrial fibrillation, as well as exploring how Factor XI inhibitors may transform anticoagulation by reducing thrombosis without increasing bleeding.

The panel explore the evolving landscape of Factor XI inhibition, discussing how antisense oligonucleotides, monoclonal antibodies and small molecules may complement or compete with one another in clinical use. The panel examine key pharmacologic distinctions among these agents and the potential barriers to their successful implementation in practice.

Key questions addressed: 

"How do you see the relative roles of antisense oligonucleotides, monoclonal antibodies, and small molecules evolving, are they complementary or competing strategies?"

"What barriers do you foresee in bringing FXI inhibitors to clinical practice?"

The panel discuss key lessons from phase 2 Factor XI inhibitor trials and how these findings informed the design of large phase 3 programmes, shaping dosing strategies, safety expectations and future clinical implementation.

Key questions addressed: 

"What lessons from phase 2 shaped phase 3 programs like LIBREXIA?"

The panel examines how safety and efficacy considerations have shaped ongoing Factor XI inhibitor trials, contrasting outcomes from different programmes and exploring why dose selection, compound properties and trial design are critical to success.

Key questions addressed: 

"We have spoken of the challenges to convince patients to remain on DOACs because of the bleeding risk. Is the opposite challenge seen in the recruitment of trials for Factor XI, with efficacy data to date not having proven superiority to DOACs?"

The panel explores which patient populations may gain the most from Factor XI inhibition, ranging from those at high bleeding risk or unable to tolerate DOACs, to broader use in ACS and stroke prevention if efficacy and safety are confirmed in phase 3 trials.

Key questions addressed: 

"Are there groups where you anticipate FXI inhibitions could become the preferred treatment?"

"In the case of AF, are Factor XI drugs beneficial for all AF patients or only those high-risk patients who cannot take DOACs?"

The panel discusses how clinicians should interpret CHA₂DS₂-VASc and HAS-BLED scores when they conflict, emphasising that bleeding risk tools should guide mitigation, not anticoagulation decisions, and explore how safer agents like Factor XI inhibitors might shift future practice.

Key questions addressed: 

"In practice, how do you weigh CHA₂DS₂-VASc versus bleeding scores like HAS-BLED when they point in different directions for a single patient?"

In closing, the panel reflects on the limitations of current anticoagulants and the promise of Factor XI inhibition to decouple thrombosis prevention from bleeding risk, potentially redefining treatment strategies across atrial fibrillation, ACS and stroke prevention.

Key questions addressed: 

"What are the limitations of current care and the potential role of factors XI inhibitors?"