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The phase 3 LIBREXIA trial evaluating milvexian, an oral factor XIa inhibitor, was halted early for futility in patients with recent acute coronary syndrome at high risk for recurrent ischemic events. Milvexian added to antiplatelet therapy did not reduce cardiovascular death, MI, or ischemic stroke compared with placebo, though no excess bleeding risk was observed.

Digest: This trial demonstrates that factor XIa inhibition does not provide additional ischemic protection in ACS patients on antiplatelet therapy, though the lack of bleeding signal may inform ongoing anticoagulation strategies in structural heart interventions where thrombotic and hemorrhagic balance is critical.

A biomarker enzyme ratio shows potential for predicting stroke and atrial fibrillation risk following transcatheter aortic valve replacement. The diagnostic tool could enable cardiologists to identify high-risk TAVR patients requiring enhanced monitoring or prophylactic intervention.

Digest: Risk stratification biomarkers for post-TAVR cerebrovascular and arrhythmic complications could improve patient selection, personalize antithrombotic strategies, and reduce adverse events in an expanding TAVR population.

New data confirm that single antiplatelet therapy (SAPT) after transcatheter aortic valve replacement demonstrates key clinical benefits compared to dual antiplatelet therapy (DAPT). The findings support a streamlined antithrombotic strategy that may reduce bleeding complications while maintaining efficacy.

Digest: This evidence could influence anticoagulation management protocols post-TAVR, potentially reducing bleeding risk and healthcare costs while simplifying patient management for the growing TAVR population.