Targeting the Intrinsic Pathway: Is Factor XI Inhibition Poised to Redefine Stroke Prevention in AF: EP Edge August 2025 Issue 4A

What if stroke prevention in atrial fibrillation no longer meant trading protection for bleeding risk?Factor XI inhibition—led by trials like AZALEA–TIMI 71, LILAC–TIMI 76, and LIBREXIA–AF—is poised to rewrite the anticoagulation playbook. By targeting the intrinsic pathway, these agents may decouple thromboembolic protection from major bleeding, potentially reshaping the role of left atrial appendage occlusion (LAAO) in stroke prevention strategies.In this episode of EP Edge, Dr. Niraj Sharma breaks down the evolving data, drug classes, mechanistic rationale, and implications for future guidelines—while also looking at where structural interventions may still fit in this shifting landscape.For: Source data/infographics see EPEDGE Newsletter on LinkedIn For feedback, collaborations, or questions, email Dr. Niraj Sharma at epedgecast@gmail.com or connect on LinkedIn