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Thromb Haemost 2025; 125(01): 082-084
DOI: 10.1055/a-2347-4338
Letter to the Editor

Risk of Major Bleeding with Antiplatelet and/or Anticoagulation Therapy in Inherited Factor XI Deficiency: Insights from Real-World Observations

Shanni Vaismann
1   Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
2   Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Nili Stein
3   Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Liat Dizengoff
2   Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Amir Warwar
1   Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
2   Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Shoshan Perek
2   Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Ibraheem Zoabi
2   Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Walid Saliba
1   Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
3   Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
,
Meir Preis
1   Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
2   Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
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Introduction

Severe factor XI (FXI) deficiency is reported to have prevalence of 1:450 within the Ashkenazi Jewish community.[1] More modest FXI deficiency has been estimated to be more common at 1:10,000–50,000.[2]

FXI is part of the coagulation cascade and is essential in the propagation of the coagulation cascade and thrombin generation.[3] [4] There is a poor correlation between decreased FXI activity and bleeding tendency except during interventions in areas with high fibrinolytic activity.[5]

It has been postulated that an underlying cardiovascular benefit may protect the FXI-deficient subjects from developing an adverse cardiovascular event or venous thromboembolism. In the largest cohort published to date, we have demonstrated that inherited FXI deficiency confers significant cardiovascular benefit.[6]

However, some of these patients require anticoagulation or antiplatelet therapy for primary or secondary prevention of cardiovascular complications. It is unknown whether the use of these medications increases the risk for bleeding in the setting of decreased FXI levels.[7]

Authors' Contribution

V.S., N.S., W.S., and M.P. designed the study. V.S., L.D., A.W., S.P., and I.Z. collected the data. N.S., W.S., and M.P. analyzed the data. M.P. and N.S. wrote the manuscript.




Publication History

Received: 12 June 2024

Accepted: 15 June 2024

Accepted Manuscript online:
18 June 2024

Article published online:
04 July 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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