Can an antithrombotic meaningfully reduce the risk of recurrent ischemic stroke without increasing major bleeding? Drs. Mike Sharma, Ashkan Shoamanesh, and Brian Mac Grory explore the science behind factor XIa inhibition and its potential to decouple thrombosis from hemostasis. The panel reviews pivotal OCEANIC-STROKE results presented at ISC 2026, highlighting a 26% relative risk reduction in ischemic stroke without an observed increase in ISTH major bleeding. They examine outcomes across stroke subtypes and place these results in context with other agents in development, such as milvexian and abelacimab. This conversation considers whether factor XI inhibition may alter long-standing assumptions about the tradeoff between efficacy and safety in secondary stroke prevention.
FXIa Remix! Keeping the Flow Without Missing a Beat
Commercial Support
This activity is supported by an independent educational grant from Bayer AG.
Disclosure of Relevant Financial Relationships
In accordance with the ACCME Standards for Integrity and Independence, it is the policy of MEDCON International that faculty and other individuals who are in the position to control the content of this activity disclose any real or apparent financial relationships relating to the topics of this educational activity. MEDCON International has full policies in place that have identified and mitigated financial relationships and conflicts of interest to ensure independence, objectivity, balance, and scientific accuracy prior to this educational activity.
The following faculty/staff members have reported financial relationships with ineligible companies within the last 24 months.
Faculty:
Brian Mac Grory, MB, BCh BAO, MRCP, FAHA, FANA
Neurologist
Vascular Neurology
Duke University
Durham, NC, USA
Dr. Mac Grory has nothing to disclose.
Mike Sharma, MD, MSc, FRCPC
Professor of Medicine (Neurology)
Hamilton General Hospital
Hamilton, Canada
Research: Alexion, AstraZeneca, Bayer, BMS, Janssen, Javelin Medical
Consulting Fees: Anthos, AstraZeneca, Bayer, Janssen, Novartis, Regeneron, Vividion
Ashkan Shoamanesh, MD, FRCPC, FESO
Associate Professor of Medicine
McMaster University
Hamilton, Canada
Research: Bayer
Consulting Fees: Bayer
Reviewers/Content Planners/Authors:- Cindy Davidson has no relevant relationships to disclose.
- Amy Burdette has no relevant relationships to disclose.
- Brian P. McDonough, MD, FAAFP, has no relevant relationships to disclose.
Learning Objectives
Upon completion of this activity, learners should be better able to:
- Describe the mechanistic rationale of factor XIa inhibition, including how selective targeting of upstream coagulation pathways may reduce thrombotic risk while preserving physiological hemostasis compared with conventional anticoagulant strategies
- Critically appraise emerging clinical trial evidence on factor XIa inhibitors, with attention to stroke recurrence reduction, bleeding outcomes, and the implications of these data for risk–benefit assessment in secondary stroke prevention
Target Audience
This activity has been designed to meet the educational needs of neurologists and hematologists as well as all other healthcare professionals involved in managing patients with stroke.
Accreditation and Credit Designation Statements
This activity has been accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®).
EBAC® holds an agreement on mutual recognition of substantive equivalency with the US Accreditation Council for CME (ACCME) and the Royal College of Physicians and Surgeons of Canada, respectively.
Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) and the American Medical Association, physicians may convert EBAC® External CME credits to AMA PRA Category 1 Credits™. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other health care professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 Credit™.
EBAC® is a member of the International Academy for CPD Accreditation (IACPDA), the World Federation for Medical Education (WFME) CPD Recognition Committee, and a partner member of the International Association of Medical Regulatory Authorities (IAMRA).
This enduring activity is accredited by the European Board for Accreditation of Continuing Education for Health Professional (EBAC®) for 30-minutes of effective education time. Provider(s)/Educational Partner(s)
Today’s healthcare environment is constantly evolving and advances of medical science occur at an accelerating pace. CME/CE plays an important role in the clinical environment and is an essential element of physician training, learning, and improvement, thereby importantly contributing to optimal patient care. Since 2000, MEDCON’s mission is to deliver high quality within the world of medical education by creating forums like PACE-CME, organizing live meetings, and providing online education. We aim to stimulate the review, exchange, and assimilation of key scientific findings to improve patients’ health, to raise awareness of new science underlying various disease states, and to accelerate the translation of this information into clinical practice.Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of MEDCON. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience, and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information.
Reproduction Prohibited
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