Mahir Khalil Ibrahim Jallo/LinkedIn
Aug 31, 2026, 14:32
Mahir Khalil Ibrahim Jallo: Hot Topic From The ESC 2026 Munich
Mahir Khalil Ibrahim Jallo, Clinical Professor of Medicine and Senior Consultant Internal Medicine at Thumbay University Hospital in Thumbay Medicity, shared a post on LinkedIn:
”Hot Topic From The ESC 2026 Munich
Here is the LIBREXIA ACS summary .. Hot Line presented today 29 August .. simultaneously in NEJM.
- What it tested .. Factor XIa inhibitor Milvexian 25 mg twice daily vs placebo, on top of standard dual antiplatelet therapy (DAPT) after recent Acute Coronary Syndrome (ACS). Background idea that Factor XI needed for thrombosis but not for hemostasis leading to anticoagulation without bleeding.
- Enrolled 16,000 patients (part of LIBREXIA program 50,000 patients total). High-risk ACS within 7 days.
- Result .. negative for efficacy. Primary endpoint (CV death plus MI plus ischemic stroke) was 5.4 percent for Milvexian vs 5.1 percent placebo .. No difference.
- Trial stopped early Nov 2025 for futility at interim analysis — unlikely to meet efficacy endpoint.
- Safety .. Reassuring.
- Principal safety endpoint (intracranial or fatal bleeding): no difference vs placebo, equally low.
- No increase in major bleeding despite adding anticoagulant to DAPT.
Bottom line … Milvexian fails in ACS setting as does not reduce recurrent events, but proves factor XIa inhibition can be added safely without fatal bleeding. Focus now shifts to AF and stroke.”
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