Factor XIa Inhibitors for Secondary Prevention After Noncardioembolic Stroke: A Systematic Review and Meta-Analysis

Patients with noncardioembolic ischemic stroke or transient ischemic attack (TIA) remain at substantial risk of recurrent ischemic events, despite guideline-recommended antithrombotic therapy. Factor XIa (FXIa) inhibitors may reduce thrombotic risk while preserving hemostasis.

We systematically searched MEDLINE and Scopus for randomized-controlled clinical trials (RCTs) comparing FXIa inhibitors with placebo in patients with acute noncardioembolic ischemic stroke or TIA. Primary efficacy outcome was first stroke (ischemic, hemorrhagic, or undefined), and primary safety outcome was first major bleeding event during follow-up. Risk ratios (RRs) with 95% CIs were pooled using random-effects models.