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Clinical trials are testing Factor XIa inhibitors as an alternative to direct oral anticoagulants, with the assumption that they are equally effective but cause fewer bleeding events. Phase II trials have shown that direct inhibitors of factor XIa may cause fewer bleeding events, but their efficacy for the prevention of first-ever and recurrent ischaemic stroke or recurrent major coronary artery events remains uncertain. However, a proof-of-principle, phase II clinical trial published in 2015 showed that an antisense oligonucleotide against F11 was as safe and effective as low-molecular-weight heparin in reducing the risk of postoperative thrombosis, paving the way for further studies in patients with arterial thromboembolism
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