This program, originally presented at HRS 2026, examines the emerging role of factor XI/XIa inhibition as a potential next-generation anticoagulation strategy for stroke prevention in atrial fibrillation (SPAF), with a primary focus on the ongoing Phase 3 trials LIBREXIA-AF and LILAC-TIMI 76. Through expert-led discussion, case-based learning, and interactive analysis of pivotal clinical data, the program offers a review of the biologic rationale for targeting FXI/XIa, lessons learned from OCEANIC-AF, and the evolving evidence surrounding oral small-molecule inhibitors such as milvexian and monoclonal antibody approaches such as abelacimab. Designed for electrophysiologists, cardiologists, stroke neurologists, and multidisciplinary AF care teams, the activity will explore how FXI/XIa inhibition could potentially reshape the balance between thromboembolic protection and bleeding risk, influence future guidelines and shared decision-making, and expand anticoagulation options for patients who are poorly served by current DOAC-based strategies.
Electrophysiologists and other cardiologists and the APPs who support them, stroke neurologists, and the broad scope of healthcare providers who contribute to the ongoing care of patients with atrial fibrillation and risk of thromboembolic stroke.
Describe the biologic and mechanistic rationale for targeting factor XI/XIa in SPAF, and contrast FXI/XIa‑directed strategies with current factor Xa‑based DOAC therapy
Differentiate mechanistic approaches to FXI pathway modulation—including zymogen‑level inhibition with a monoclonal antibody and active‑site inhibition with oral small‑molecule FXIa inhibitors—and discuss how these differences may translate into distinct clinical profiles
Evaluate the design, populations, and key endpoints of LIBREXIA‑AF and LILAC‑TIMI 76 in the context of prior FXI/XIa inhibitor trials (including OCEANIC‑AF) to assess how these ongoing Phase 3 programs test the FXI/XIa hypothesis in AF
Assess how potential efficacy and bleeding outcomes across FXI/XIa inhibitor programs could influence guideline recommendations; risk–benefit discussions; anticoagulant selection in diverse AF patient populations, including those unsuitable for current DOACs; current electrophysiology and AF clinic workflows; shared decision making in SPAF; and coordination across multidisciplinary care teams
Welcome & Introductions - Alexis Tumolo, MD
Why Rethink Anticoagulation in AF? - Tina Baykaner, MD & Alexis Tumolo, MD
FXI/XIa Biology and Therapeutic Rationale: From Zymogen Targeting to Active‑site Inhibition - Geoffrey Barnes, MD
Lessons Learned from OCEANIC‑AF - Geoffrey Barnes, MD
Concise review of LIBREXIA‑AF and LILAC‑TIMI 76: Potentially Complementary Phase 3 Tests of FXI/XIa Inhibition in AF - Tina Baykaner, MD & Alexis Tumolo, MD
Practical Integration: What Would FXI/XIa Inhibition Look Like in My Lab and Clinic? – All Faculty
Q&A and Wrap-Up -All Faculty
Disclosures of Relevant Financial Relationships
It is the policy of AcademicCME that all faculty, instructors, and planners disclose relevant financial relationships with ineligible companies. Planners have no relevant financial relationships with ineligible companies to disclose related to this activity. Faculty have disclosed the following relevant financial relationships. All relevant financial relationships have been mitigated.
| Faculty | Relationship Identified With: |
| Alexis Tumolo, MD | Education Support: Abbott
Speaker: Biosense Webster, Inc.; Boston Scientific Corporation |
| Geoffrey Barnes, MD
|
Consultant/Advisor: Abbott Vascular; Anthos Therapeutics; AstraZeneca; Bayer AG; Boston Scientific Corporation; Bristol-Myers Squibb Company; Janssen; Pfizer Inc.; Sanofi
Grant Funding: Boston Scientific Corporation Board of Directors: Anticoagulation Forum |
| Tina Baykaner, MD | Consultant/Advisor: Abbott; Biotronik; Boston Scientific Corporation; iRhythm Technologies, Inc.; Johnson & Johnson; Medtronic; PaceMate; Volta Medical
Speaker: Medtronic; Abbott; Biotronik; Boston Scientific Corporation; Johnson & Johnson; PaceMate Grant Funding: Janssen |
Timothy Hayes, MD, PhD; Kim Cheramie, PhD, MSN, RN, NPDA-BC, Chelsey Simonds and Nicole McMenamin hereby state that they or their spouse/life partner do not have any relevant financial relationships to products or devices with any commercial interests related to the content of this activity of any amount during the past 12 months.
In support of improving patient care, AcademicCME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
AcademicCME designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™; 1.25 CNE Contact Hours, including 1.25 Pharmacotherapeutic Contact Hours (Provider #P0491); and 1.25 CPE Contact Hours (0.125 CEUs) of Continuing Pharmacy Education Credit (UAN # JA4008190-0000-26-012-H01-P).
Participants should claim only the credit commensurate with the extent of their participation in the activity.
This activity has been supported by an independent educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. AcademicCME and the Bristol Myers Squibb and Johnson & Johnson Alliance do not recommend the use of any agent outside of the labeled indications.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. 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 patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
In order to claim credit, participants must complete the following:
For all CE inquiries or special needs, please contact admin@academiccme.com.
