Is it safe to take abelacimab before a procedure?

Patients with atrial fibrillation (AF) who have been treated with the long-acting factor XI inhibitor abelacimab may undergo invasive procedures, as shown by the low rates of bleeding in a recent study.

Some 441 patients underwent a total of 920 procedures. Approximately one in three patients in both the rivaroxaban and abelacimab arms had an invasive procedure over a median follow-up of 2.1 years. Most procedures were low bleeding risk (75.7 percent) and elective (74.6 percent).

The median time to a procedure from the last abelacimab dose was 29 days. More than half of the procedures (336/602, 55.8 percent) in the abelacimab arms occurred within the monthly dosing interval.

A low occurrence (<2 percent) of periprocedural major or clinically relevant nonmajor (CRNM) bleeding was observed, accounting for 1.2 percent of all procedures in the abelacimab arms as opposed to 2.2 percent in the rivaroxaban arm (risk ratio, 0.54, 95 percent confidence interval, 0.19‒1.58). Results were consistent in the individual abelacimab dosing arms.

For procedures occurring within a month of abelacimab use, major or CRNM bleeding occurred in only three of the 336 (0.9 percent) procedures.

“Moreover, these findings suggest that routine interruption of anticoagulation may not be necessary for all procedures in the context of factor XI inhibition, particularly for procedures that have low bleeding risk,” the researchers said.

This study randomized participants to either one of two abelacimab doses (90 or 150 mg subcutaneously monthly) or to rivaroxaban daily. The research team categorized invasive procedures occurring during follow-up as follows: low, intermediate, or high bleeding risk.

Periprocedural bleeding events were identified as major/CRNM bleeds, as adjudicated by a clinical events committee blinded to treatment assignment, occurring within 30 days after a procedure.