Sep 28, 2026 · 10 min · 9 segments
In this first episode of a special ISTH Pulse Podcast miniseries, the discussion explores why next-generation mimetic therapies may be needed and where current treatment approaches may still leave…
Jeffrey WeitzGuest
Mike SharmaGuest
Geoffrey BarnesHostHi, everyone.
I'm Dr. Deborah Siegel, and we're fortunate today to be with Dr. Weitz, Dr. Sharma, and Dr. Barnes to talk about Factor XI inhibition for the treatment of secondary prevention of stroke.
Dr. Sharma, help us understand the need for improved treatments for patients who've experienced non-cardioembolic ischemic stroke.
Cardiobolic stroke, most of which is related to AF, has very good secondary prevention.
Anticoagulation morphine is about 66% effective at reducing risk compared to placebo, and the DOACs have built on that, more convenient in the ears and somewhat greater safety for internal hemorrhage.
Non-cardiobolic ischemic stroke, which is about 8% of the total ischemic strokes we see, however, does not have that same option for antithrombotic therapy.
So aspirin is the mainstay of secondary prevention in non-cardiobolic ischemic stroke, and that's been there for about 50 years.
And in spite of attempts with previous trials, we've not managed to build on aspirin.
apart from a short-term dual antiplatelet therapy for about three weeks, which is effective.
For most people, long-term, it's aspirin, which is effective, but modestly so, about a 20% relative risk reduction.
So we have this large group of patients with non-cardiobolic ischemic stroke where we're stuck where we were in the 70s.
Hi, everyone.
I'm Dr. Deborah Siegel, and we're fortunate today to be with Dr. Weitz, Dr. Sharma, and Dr. Barnes to talk about Factor XI inhibition for the treatment of secondary prevention of stroke.
Dr. Sharma, help us understand the need for improved treatments for patients who've experienced non-cardioembolic ischemic stroke.
Cardiobolic stroke, most of which is related to AF, has very good secondary prevention.
Anticoagulation morphine is about 66% effective at reducing risk compared to placebo, and the DOACs have built on that, more convenient in the ears and somewhat greater safety for internal hemorrhage.
Non-cardiobolic ischemic stroke, which is about 8% of the total ischemic strokes we see, however, does not have that same option for antithrombotic therapy.
So aspirin is the mainstay of secondary prevention in non-cardiobolic ischemic stroke, and that's been there for about 50 years.
And in spite of attempts with previous trials, we've not managed to build on aspirin.
apart from a short-term dual antiplatelet therapy for about three weeks, which is effective.
For most people, long-term, it's aspirin, which is effective, but modestly so, about a 20% relative risk reduction.
So we have this large group of patients with non-cardiobolic ischemic stroke where we're stuck where we were in the 70s.
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