{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:18:15Z","timestamp":1791235095335,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Combining antiplatelet therapy (APT) with conventional anticoagulants increases the risk of bleeding. In the AZALEA-TIMI 71 trial (Safety and Tolerability of Abelacimab [MAA868] vs Rivaroxaban in Patients With Atrial Fibrillation), the novel factor XI inhibitor abelacimab significantly reduced the risk of bleeding compared with rivaroxaban in patients with atrial fibrillation. Whether the safety of combination antithrombotic therapy differs in the context of factor XI inhibition has not been well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This prespecified analysis of AZALEA-TIMI 71, which randomized patients between March and December of 2021 to 1 of 2 subcutaneous monthly abelacimab doses (90 or 150 mg) or oral rivaroxaban (20 mg daily, dose reduced to 15 mg in patients with creatinine clearance \u226450 mL\/min), stratified patients by planned use of concomitant APT. The primary composite end point of major or clinically relevant nonmajor bleeding and other safety and efficacy outcomes were examined by concomitant APT and randomized treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 1287 patients (44% female; median age 74 years [interquartile range, 69\u201378]), 318 (24.7%) were on APT at baseline with planned continuation (15.5% aspirin only, 7.5% P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor only, and 1.6% dual APT). In the rivaroxaban arm, the rate of major or clinically relevant nonmajor bleeding was 10.6 per 100 patient-years with concomitant APT versus 7.7 per 100 patient-years without. In the abelacimab arms, the rates were 2.5 and 3.5 per 100 patient-years for the 90-mg and 150-mg doses, respectively, with concomitant APT and 2.7 and 3.1 per 100 patient-years without. Each abelacimab dose significantly reduced major or clinically relevant nonmajor bleeding compared with rivaroxaban, both in those with concomitant APT (adjusted hazard ratio, 0.26 [95% CI, 0.10\u20130.70] and 0.30 [95% CI, 0.12\u20130.74] for 90 mg and 150 mg of abelacimab, respectively, versus rivaroxaban) and in those without concomitant APT (adjusted hazard ratio, 0.34 [95% CI, 0.19\u20130.60] and 0.40 [95% CI, 0.23\u20130.68] for 90 mg and 150 mg of abelacimab, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interactions<\/jats:sub>\n                      =0.56 and 0.60, respectively). Patients with concomitant APT tended to derive greater absolute risk reductions with abelacimab (8.1 and 7.1 for 90 mg and 150 mg of abelacimab, respectively, versus rivaroxaban) than those without concomitant APT (5.0 and 4.6, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Inhibition of factor XI with abelacimab consistently reduced bleeding compared with rivaroxaban regardless of concomitant APT use, with greater absolute reductions in bleeding in those requiring concomitant APT. These data suggest that factor XI inhibition may be a safe anticoagulant option in patients with atrial fibrillation requiring concomitant APT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04755283.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.074037","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T05:00:14Z","timestamp":1750654814000},"page":"290-296","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Abelacimab Versus Rivaroxaban in Patients With Atrial Fibrillation on Antiplatelet Therapy: A Prespecified Analysis of the AZALEA-TIMI 71 Trial"],"prefix":"10.1161","volume":"152","clinical-trial-number":[{"clinical-trial-number":"nct04755283","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3262-3785","authenticated-orcid":true,"given":"Samer","family":"Al Said","sequence":"first","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4637-4361","authenticated-orcid":true,"given":"Siddharth M.","family":"Patel","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-7675","authenticated-orcid":true,"given":"Robert P.","family":"Giugliano","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9589-5382","authenticated-orcid":true,"given":"David A.","family":"Morrow","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8541-264X","authenticated-orcid":true,"given":"Erica L.","family":"Goodrich","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8231-3611","authenticated-orcid":true,"given":"Sabina A.","family":"Murphy","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Hug","sequence":"additional","affiliation":[{"name":"Anthos Therapeutics, Inc, Cambridge, MA (B.H., S.P., D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanobar","family":"Parkar","sequence":"additional","affiliation":[{"name":"Anthos Therapeutics, Inc, Cambridge, MA (B.H., S.P., D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9085-0823","authenticated-orcid":true,"given":"Shih-Ann","family":"Chen","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Taipei Veterans General Hospital, Taiwan (S.-A.C.)."},{"name":"Cardiovascular Center, Taichung Veterans Hospital, Taiwan (S.-A.C.)."},{"name":"Cardiovascular Center, China Medical University Hospital, Taiwan (S.-A.C.)."},{"name":"National Yang Ming Chiao Tung University, Taiwan (S.-A.C.)."},{"name":"National Chung Hsing University, Taiwan (S.-A.C.)."},{"name":"China Medical University, Taiwan (S.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8068-2440","authenticated-orcid":true,"given":"Shaun G.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, St Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Canada (S.G.G.)."},{"name":"Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.G.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9036-7225","authenticated-orcid":true,"given":"Boyoung","family":"Joung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (B.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0514-7530","authenticated-orcid":true,"given":"Robert G.","family":"Kiss","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Central Hospital of Northern Pest-Military Hospital, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (R.G.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3681-5207","authenticated-orcid":true,"given":"Wojciech","family":"Wojakowski","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (W.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-7550","authenticated-orcid":true,"given":"Jeffrey I.","family":"Weitz","sequence":"additional","affiliation":[{"name":"Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Canada (J.I.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Bloomfield","sequence":"additional","affiliation":[{"name":"Anthos Therapeutics, Inc, Cambridge, MA (B.H., S.P., D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0691-3359","authenticated-orcid":true,"given":"Marc S.","family":"Sabatine","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4712-3206","authenticated-orcid":true,"given":"Christian T.","family":"Ruff","sequence":"additional","affiliation":[{"name":"TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (S.A.S., S.M.P., R.P.G., D.A.M., E.L.G., S.A.M., M.S.S., C.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050438"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013252.pub2"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1904143"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00456-1"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2043-0346"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.062353"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01588-4"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.061612"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00403-9"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartjsupp\/suae013"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-10-880849"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2406674"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13140"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.2307\/2337177"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002587"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/2048872618796990"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad655.2849"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611594"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1708454"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1817083"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31872-0"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.6175"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz732"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.06.022"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1112277"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr113"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105819"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709118"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2000052"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD014678.pub2"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001627"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.125.074037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T18:00:26Z","timestamp":1754330426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.125.074037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,5]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,8,5]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.125.074037"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.125.074037","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,5]]},"assertion":[{"value":"2025-01-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}