Factor XI Antibody Abelacimab Cuts Bleeding Versus Rivaroxaban in AF

AZALEA-TIMI 71 provides the longest-term human evidence that factor XI inhibition markedly reduces anticoagulant-associated bleeding compared with a direct oral anticoagulant, though efficacy remains unproven.

abelacimabrivaroxabanfactor XI inhibitorfactor XIamonoclonal antibodyatrial fibrillationanticoagulationstroke preventionbleedinggastrointestinal bleedingDOACAZALEA-TIMI 71phase 2b RCT Cardiology / Anticoagulation

Background Information

Abelacimab cuts bleeding risk in atrial fibrillation patients.

Abelacimab demonstrates a significant reduction in bleeding events compared to rivaroxaban in patients with atrial fibrillation, presenting a potentially safer anticoagulation option. Abelacimab 150mg and 90mg showed a median reduction in free factor XI activity of 99% and 97% respectively. Bleeding rates per 100 person-years were significantly lower in the abelacimab groups compared to rivaroxaban (HR 0.38 for 150mg, P<0.001). This trial suggests abelacimab may provide a safer anticoagulation strategy with fewer bleeding risks, but further studies are required to confirm long-term efficacy and safety in diverse populations. Abelacimab significantly reduces bleeding compared to rivaroxaban in atrial fibrillation patients.

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Authors: Ruff CT, Patel SM, Giugliano RP, Morrow DA, Hug B, Kuder JF, Goodrich EL, Chen SA, Goodman SG, Joung B, Kiss RG, Spinar J, Wojakowski W, Weitz JI, Murphy SA, Wiviott SD, Parkar S, Bloomfield D, Sabatine MS, AZALEA–TIMI 71 Investigators

Citation: Ruff CT, Patel SM, Giugliano RP, et al. Abelacimab versus Rivaroxaban in Patients with Atrial Fibrillation. The New England journal of medicine. 2025;392(4):361-371. doi:10.1056/NEJMoa2406674

Article Links: PubMed · Journal / DOI

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