2) Follow this 🧵for 0.5hr 🆓 CE/#CME ! Don’t miss the first, still available for credit, at https://t.co/9PIJq6mcL7. This edition comes from returning expert author Marc Carrier @MarcCarrier1, Head of the Division of Hematology at The Ottawa Hospital @OttawaHospital 🇨🇦 pic.twitter.com/88pGjawsA4
— cardio-met (@cardiomet_CE) August 26, 2025
This program is supported by an independent educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance & is intended for an audience of #HCPs. Statement of accreditation & faculty disclosures are at https://t.co/gvXca4G9Xm.
— cardio-met (@cardiomet_CE) October 27, 2025
5)💓Atrial fibrillation (#AF) affects 50M+ people worldwide. Pts face a 1.5–2x ⬆️ risk of death & a 2.4x ⬆️ risk of #stroke, which is often more disabling & ➡️longer hospital stays. AF accounts for 15-22% of ischemic strokes. #AFib #StrokePrevention
— cardio-met (@cardiomet_CE) August 26, 2025
🔓 https://t.co/GG5V8Hy0pX pic.twitter.com/mPXifR3frg
7a) 💊DOACs have advantages over #VKAs: ✅ no monitoring ✅no diet limits. Yet 35–40% of #AF patients do not receive proper #anticoagulation, either left untreated or given inappropriately low doses due to bleeding concerns. #AtrialFibrillation
— cardio-met (@cardiomet_CE) August 26, 2025
🔓 https://t.co/NNqdnjAE8t pic.twitter.com/h9D7NS1ONE
8a) 🧠 Alas, #anticoagulation is not proven for secondary prevention in non-cardioembolic stroke. But 🔗 dual pathway inhibition #DPI (antiplatelet + anticoagulant) has ⬇️recurrent strokes in coronary & peripheral artery disease. #Stroke #Cardiology
— cardio-met (@cardiomet_CE) August 26, 2025
🔓 https://t.co/vCDXUTq5tR pic.twitter.com/1rgMvqRkh0
8c) Which BEST describes the rationale for #FXI/XIa inhibitors?
— cardio-met (@cardiomet_CE) August 26, 2025
A) Key for #hemostasis → ↑ bleeding
B) Essential for #thrombosis, less for hemostasis → ↓ clots, minimal bleeding
C) Only #ASOs in development
D) All trials > apixaban
10) 🧬Could Factor XI (FXI) or #FXIa inhibitors be the next big step in anticoagulation? FXI fuels clot growth via the intrinsic pathway ⚡. Blocking its activated form may ⬇️thrombosis but spare normal hemostasis. 👉 Safer than DOACs?#Thrombosis #FXI
— cardio-met (@cardiomet_CE) August 26, 2025
🔓 https://t.co/wekUrRW8Ms pic.twitter.com/bcFCVPoQkg
12) 🩸Here’s the twist: #FXIa is essential for thrombosis but seems dispensable for hemostasis. Why? Because hemostasis kicks in at vessel injury sites, powered by 🚀 high #TF levels. #Hemostasis #Thrombosis pic.twitter.com/CuT0n0tPzK
— cardio-met (@cardiomet_CE) August 26, 2025
13b) ✨ That’s why FXIa inhibitors may 🛑 formation of intraluminal clots without ⬇️ hemostasis.
— cardio-met (@cardiomet_CE) August 26, 2025
A safer path forward? #ClotScience
15) 🧬Genetics tell the same tale: in >370,000 participants (UK Biobank + #GWAS), lower #FXI levels =
— cardio-met (@cardiomet_CE) August 26, 2025
⬇️ VTE risk (OR 0.1)
⬇️ Ischemic stroke risk (OR 0.47)
❌ No major increase in bleeding risk
🔓 https://t.co/I60elPuUnz pic.twitter.com/3wrqvMkZA1
17a) 💊 The FXI/XIa inhibitor pipeline is diverse:
— cardio-met (@cardiomet_CE) August 26, 2025
1) Small molecules (e.g., Milvexian, Asundexian)
–Direct FXIa inhibitors
–Oral, QD or BID
–Short half-life (~12–20h) → flexibility, but need adherence
👉 Attractive for long-term prevention (#AF, secondary #stroke or #ACS)
17c)
— cardio-met (@cardiomet_CE) August 26, 2025
3) 🧬 Antisense oligonucleotides (#ASOs) (e.g., IONIS-FXI Rx, Fesomersen)
–Silence FXI production in the liver
–Subcutaneous injection
–Long half-life (weeks) → dosing every 1–3 months
👉 Offers steady FXI suppression
18b) ⬆️ing the unmet need: in addition to clinical stroke recurrence, there is a substantial burden of covert brain infarction during the year after stroke. Generally, covert brain infarcts have been associated with cognitive and functional decline.
— cardio-met (@cardiomet_CE) August 26, 2025
18d) But . . . #DPI substantially reduced ischemic stroke recurrence compared with #aspirin alone in patients with stable coronary and peripheral artery #atherosclerosis in the #COMPASS trial
— cardio-met (@cardiomet_CE) August 26, 2025
🔓 https://t.co/Z6xaVF5VML
🔓 https://t.co/vCDXUTq5tR
20a) FXIa inhibitors in recurrent stroke prevention
— cardio-met (@cardiomet_CE) August 26, 2025
💊 #Milvexian (oral FXIa inhibitor) 25mg BID – #LIBREXIA-STROKE
🧠 Phase 3, randomized, placebo-controlled
👥 ~15,000 pts, within 48h of ischemic stroke/high-risk TIA
21) 💊 #Asundexian (oral #FXIa inhibitor) 50mg QD – #OCEANIC-STROKE
— cardio-met (@cardiomet_CE) August 26, 2025
🧠 ~9,300 pts / 36 countries / 717 sites ⏱ Within 72h of non-cardioembolic stroke or high-risk TIA
📅 Follow-up: up to 31 mo
🎯 Add-on to antiplatelets#NCT05686070
Read-out likely in 2026!
22b) 🩺 From mechanism → epidemiology → trials: all signs point to FXI/XIa as a prime target.
— cardio-met (@cardiomet_CE) August 26, 2025
👉 Stay tuned for Phase 3 results to see if this is the future of anticoagulation.#MedEd #FOAMed #NeuroTwitter
23) And RIGHT NOW, you can claim your 0.5hr of 🆓CE/#CME by pointing your 🖱️to https://t.co/emlNEmVPTO. Many thanks to our expert author @MarcCarrier1 ! Don’t miss the next installment in this series for MORE 🆓#CE/#CME! pic.twitter.com/voH09iNyUp
— cardio-met (@cardiomet_CE) August 26, 2025