Brain and behavior
Oral Factor XIa Inhibitors for Secondary Prevention After Noncardioembolic Ischemic Stroke or High-Risk Transient Ischemic Attack: Systematic Review and Meta-Analysis
By Arshad MA, Nadeem H, Afzal M and 9 others.
Abstract
Introduction
Patients with recent noncardioembolic ischemic stroke or high-risk transient ischemic attack (TIA) remain at risk of recurrent events despite antiplatelet therapy. Oral factor XIa (FXIa) inhibitors may reduce thrombotic risk while limiting bleeding, but their adjunctive efficacy and safety require clarification.
Methods
PubMed, Embase, Cochrane Library/CENTRAL, and ClinicalTrials.gov were searched through May 2026 for randomized, double-blind, placebo-controlled trials of oral FXIa inhibitors added to antiplatelet therapy. Primary efficacy and safety outcomes were recurrent ischemic stroke and major bleeding. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models.