2) Our returning expert faculty is Ashkan Shoamanesh MD @Ash_Shoamanesh, #Stroke #Neurologist @HamHealthSci & Associate Professor @McMasterU. He is also Director of Hemorrhagic Stroke Research Program & Senior Scientist @PHRIresearch pic.twitter.com/lsz9GYRbEo
— cardio-met (@cardiomet_CE) October 14, 2025
3) This program is supported by an independent grant from the the Bristol Myers Squibb and Johnson & Johnson Alliance. It is intended for #HCPs. Statement of accreditation and faculty disclosures are at https://t.co/gvXca4G9Xm.
— cardio-met (@cardiomet_CE) October 27, 2025
5) What has been the greatest barrier to long-term dual antiplatelet therapy #DAPT for secondary stroke prevention #SSP?
— cardio-met (@cardiomet_CE) October 14, 2025
7) Why is FXIa inhibition a promising 🎯for #SSP?
— cardio-met (@cardiomet_CE) October 14, 2025
a) Pts w/inborn FXI def have ⬇️risk #IS
b) Random alloc to ⬆️ doses FXIa inhib seemed to have⬇️IS risk vs pbo in Ph 2 SSP trials.
c) Stroke pts on antiplatelet + FXIa inhib have similar major 🩸 vs pts on AP + pbo
d) all of above
9) And long-term dual antiplatelet treatment #DAPT beyond 1-3 months has demonstrated excess risk of major 🩸that is not offset by greater efficacy for stroke prevention in these patients.
— cardio-met (@cardiomet_CE) October 14, 2025
11) Ongoing research efforts to address this major unmet need to optimize secondary stroke prevention #SSP in patients with #NCIS or high-risk TIA are focusing on inhibition of coagulation #FXIa.
— cardio-met (@cardiomet_CE) October 14, 2025
12b) Thus, by inhibiting FXI/FXIa we may be able to prevent pathologic thrombus formation (i.e. ⬇️ #IS) while maintaining hemostasis (i.e. 📷 major bleeding). (https://t.co/hP728pTqWL). pic.twitter.com/FPNLQGax6x
— cardio-met (@cardiomet_CE) October 14, 2025
14a) These observations have been replicated in animal models of FXI deficiency (https://t.co/qqamuxqIVz) and…
— cardio-met (@cardiomet_CE) October 14, 2025
15) These observations ultimately led to two phase 2 trials that tested small molecule oral direct #FXIa inhibitors for #SSP in patients with #NCIS or high-risk #TIA.
— cardio-met (@cardiomet_CE) October 14, 2025
16b) Participants were recruited from 196 hospitals in 23 countries and were followed up during treatment for 26–52 weeks. (https://t.co/tk3BCXm46f) pic.twitter.com/uuDmfTROry
— cardio-met (@cardiomet_CE) October 14, 2025
16d) This was driven by lack of effect on covert infarcts, which monopolized the primary EP (75% of events) & 70% of these were small subcortical infarcts (see lack of assoc bet genetically determined #FXI levels & small vessel occlusive disease-related strokes in post 14b ⤴️). pic.twitter.com/5BvvjwNUQU
— cardio-met (@cardiomet_CE) October 14, 2025
16f) Dose-dependent ⬇️ in the exploratory outcome of #IS or TIA was also observed in secondary analyses confined to symptomatic ischemic cerebrovascular events. pic.twitter.com/cgyB2uKe8p
— cardio-met (@cardiomet_CE) October 14, 2025
16h) . . . the rate of #IS or #TIA was 16% vs. 9% with placebo and #asundexian 50 mg daily, respectively, at 10.6 months. Corresponding rates were 8 and 3% in patients with any degree of atherosclerosis visualized on vascular imaging. pic.twitter.com/7WrIYlUs3S
— cardio-met (@cardiomet_CE) October 14, 2025
16j) These findings were consistent in patients with underlying hemorrhage-prone cerebral small vessel disease marked by cerebral microbleeds on brain MRI (https://t.co/G57WbhYrsZ), and asundexian did not ⬆️ the risk of new microbleeds on MRI. pic.twitter.com/mJsLYrNmy4
— cardio-met (@cardiomet_CE) October 14, 2025
17b) However, a 1.5-fold ⬆️ in clinically relevant non-major 🩸was observed with asundexian 50 mg daily.
— cardio-met (@cardiomet_CE) October 14, 2025
See https://t.co/EYIvru1hix pic.twitter.com/VSSj3ohUt9
18b) All participants required visible atherosclerosis and received ASA+clopidogrel for 21 days followed by #ASA daily until 90 days . Patients with lacunar stroke were excluded. Enrollment occurred at 367 hospitals in 27 countries.
— cardio-met (@cardiomet_CE) October 14, 2025
18d) Rates of BARC type 3 and 5 🩸 were similar between milvexian treated and placebo treated patients, but were numerically ⬆️relative to placebo with milvexian doses above 25 mg twice daily. pic.twitter.com/5zq4VnmdV2
— cardio-met (@cardiomet_CE) October 14, 2025
19) The results of these two phase 2 trials have informed the design of two important ongoing phase 3 #RCTs; #OCEANIC-STROKE and #LIBREXIA-STROKE.
— cardio-met (@cardiomet_CE) October 14, 2025
21) LIBREXIA-STROKE is comparing milvexian 25 mg BID vs placebo on top of standard APT in patients with acute #NCIS or high-risk #TIA. The trial is actively recruiting to a target of 15,000 participants and is scheduled to report its top line results at the end of 2026. pic.twitter.com/GwtJ0uDJHi
— cardio-met (@cardiomet_CE) October 14, 2025
23) That is in the (near?) future. RIGHT NOW, you can claim your 0.5hr of CE/#CME by pointing your to https://t.co/5pQ6ChfJhk. Many thanks to our expert author @Ash_Shoamanesh!
— cardio-met (@cardiomet_CE) October 14, 2025