Blood coagulation factor XI: new strategy of targeted anticoagulant therapy

Thrombotic disease remains a leading cause of morbidity and mortality worldwide. Despite breakthroughs in anticoagulant therapy over the past decade, traditional vitamin K antagonists have been replaced by direct oral anticoagulants (DOACs) that selectively target coagulation factor Xa or IIa. However, for the growing population with concomitant diseases, there is still a lack of satisfactory treatment options. Coagulation-targeted therapy is a challenging task because it interferes with the delicate balance between procoagulant and anticoagulant activities. Epidemiological and animal studies have identified factor XI as a potential target for anticoagulation, because factor XI deficiency or inhibition can prevent thrombosis and is associated with little or no bleeding. Based on the concept of contact hemostasis, this review describes the basic principles of the development of coagulation factor XI inhibitors, elaborates on the pharmacological characteristics of existing factor XI inhibitors, and summarizes the current situation of clinical trial research, to provide some insight for the development of new anticoagulant drugs and clinical anticoagulant treatment.