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Mital Jhaveri: The Promise of Factor XI Inhibitors in Chronic Kidney Disease
Mital Jhaveri/LinkedIn
Apr 27, 2026, 13:36

Mital Jhaveri: The Promise of Factor XI Inhibitors in Chronic Kidney Disease

Mital Jhaveri, Clinical Anticoagulation, Heart Failure Pharmacist at NYC HHC Queens Hospital Center, shared on LinkedIn about a recent article by Daniel Steiner et al, published in KIREPORTS, adding:

”Factor XI Inhibitors and Kidney Disease: A Game-Changer for a Forgotten Population?

One of the most underappreciated aspects of the FXI inhibitor story isn’t atrial fibrillation or VTE – it’s kidney disease.

The challenge we face includes:

  • Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are at high risk for both thrombosis and bleeding.
  • Most direct oral anticoagulants (DOACs) have significant renal clearance, making them unsafe or contraindicated in severe CKD.
  • Warfarin is notoriously difficult to manage in this population.
  • Clinically relevant bleeding in anticoagulated dialysis patients can exceed 30%.

This situation leaves us hesitant to treat patients who need anticoagulation the most.

Factor XI inhibitors offer a different approach:

  • Many FXI inhibitors have minimal to no renal clearance.
  • FXI plays a greater role in pathological thrombosis than in normal hemostasis, making it safer for fragile patients.
  • FXI is activated by artificial surfaces such as dialysis circuits and catheters, making it a mechanistically ideal target.

Phase II trials are already showing promise:

  • The CONVERT trial with osocimab in hemodialysis showed no increase in bleeding compared to placebo.
  • The RE-THINc ESRD trial with fesomersen was well-tolerated, with pharmacokinetics unchanged before or after dialysis.
  • The EMERALD trial with FXI-ASO in ESRD demonstrated reduced FXI activity without a major increase in bleeding.

Phase III (LILAC-TIMI 76) is now enrolling ESKD patients.

For the nephrology and hematology community, this may represent the most clinically impactful application of FXI inhibition yet.”

Title: A Systematic Review of Safety and Efficacy of Factor XI/XIa Inhibitors in Patients With ESKD on Hemodialysis

Authors: Daniel Steiner, Daniel Kraemmer, Stephan Nopp, Oliver Königsbrügge, Cihan Ay

Mital Jhaveri: The Promise of Factor XI Inhibitors in Chronic Kidney Disease

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bleeding disorders Cihan Ay CKD Daniel Kraemmer Daniel Steiner DOACs ESKD Factor XI Inhibitors Health Hematology Hemophilia Hemostasis Hemostasis News Hemostasis Today kidney disease KIREPORTS Medicine Mital Jhaveri Oliver Königsbrügge Stephan Nopp VTE Warfarin
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