WSC 2026 | The future of factor XI inhibitors in secondary stroke prevention: asundexian and beyond

S. Claiborne Johnston, MD, PhD, Harbor Health, Austin, TX, and UCSF, San Francisco, CA, discusses the future of factor XI inhibitors in secondary stroke prevention. Dr Johnston highlights the positive OCEANIC-STROKE trial (NCT05686070), in which asundexian reduced the risk of stroke without a meaningful increase in bleeding in patients with minor ischemic stroke or high-risk transient ischemic attack (TIA), and the ongoing LIBREXIA-STROK trial (NCT05702034) of milvexian. He also discusses ongoing trials in patients with atrial fibrillation, including antibody-based approaches in patients unsuitable for anticoagulation, and potential future applications of this drug class. This interview took place at the 18th World Stroke Congress (WSC) in Seoul, Korea.

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