OCEANIC-AF: Asundexian Fails Stroke Prevention Versus Apixaban

This phase 3 trial demonstrates that the factor XIa inhibitor asundexian at 50 mg once daily is substantially inferior to apixaban for stroke prevention in atrial fibrillation, despite lower bleeding, closing the door on this dose and challenging the factor XIa-in-AF hypothesis.

📅 Journal publication: Jan 2, 2025 (online Sep 1, 2024) · Last updated: Sep 7, 2026

asundexianapixabanfactor XIa inhibitordirect oral anticoagulantatrial fibrillationstroke preventionanticoagulationOCEANIC-AFbleedingphase 3 trial Anticoagulation / Hematology

Background Information

Asundexian falls short on stroke prevention in AFib but cuts bleeding.

There is a need for effective stroke prevention with reduced bleeding risk in atrial fibrillation (AFib). Asundexian showed higher stroke or systemic embolism rates but fewer major bleeds compared to apixaban. The study suggests that while asundexian reduces bleeding, its lower efficacy for stroke prevention in AFib limits its use compared to apixaban. Asundexian offers less stroke protection but fewer bleeds than apixaban in AFib.

📊 Deep Analysis Available

Subscribers get the full breakdown: study design, outcomes, pharmacist implications, clinical pearls, GRADE evidence grade, and a downloadable PDF report.

Subscribe for Full Access →

Authors: Piccini JP, Patel MR, Steffel J, Ferdinand K, Van Gelder IC, Russo AM, Ma CS, Goodman SG, Oldgren J, Hammett C, Lopes RD, Akao M, De Caterina R, Kirchhof P, Gorog DA, Hemels M, Rienstra M, Jones WS, Harrington J, Lip GYH, Ellis SJ, Rockhold FW, Neumann C, Alexander JH, Viethen T, Hung J, Coppolecchia R, Mundl H, Caso V, OCEANIC-AF Steering Committee and Investigators

Citation: Piccini JP, Patel MR, Steffel J, et al. Asundexian versus Apixaban in Patients with Atrial Fibrillation. The New England journal of medicine. 2025;392(1):23-32. doi:10.1056/NEJMoa2407105

Article Links: PubMed · Journal / DOI

🎓

Reviewed by a licensed pharmacist

Every analysis is reviewed and approved by a licensed pharmacist before publication, ensuring clinical accuracy and relevance.

Accurate and up-to-date information is our highest priority.

If you spot an error, please suggest a correction. If there is a topic you want covered, tell us and we will look at it.

Suggest a correction Request a topic

Thanks for the feedback!

🔒

Deep Analysis: Subscribers Only

Subscribers receive access to a complete clinical analysis, available online and as a downloadable PDF.

Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

Want the full analysis?

Subscribe to PharmD Signal for unrestricted access to every deep analysis, plus PDF reports, GRADE evidence grades, and pharmacist implications for every article we publish.

Become a Subscriber →