抗凝治疗适用于治疗和预防动脉和静脉血栓形成。针对凝血过程的不同步骤，目前可用的抗凝剂会增加出血风险，这对预后产生不利影响，并阻碍有效抗血栓治疗方案的实施。 XI 因子 (FXI) 抑制已成为一种将预防血栓形成与出血脱钩的策略。事实上，虽然 FXI 对于病理性血栓形成的放大阶段至关重要，但它在生理性止血中起辅助作用。我们对多个科学数据库进行了全面检索，以确定该领域的相关研究。此外，还在适当的数据集中搜索正在进行的试验，以便对 FXI 抑制研究的当前状态提供更新和全面的评估。许多化合物已被测试可在不同阶段（即合成、激活或与靶分子和凝血因子相互作用）抑制 FXI。这些包括反义寡核苷酸、单克隆抗体、小分子、天然肽和适体。在 2 期研究中，FXI 抑制剂减少了血栓并发症，但出血量没有相应增加。在骨科手术中，FXI 抑制剂不劣于甚至可能优于低分子量肝素，并且与房颤患者的阿哌沙班相比，可减少出血。 FXI 抑制也在其他条件下进行测试，包括终末期肾病、癌症或非心源性中风。 FXI 抑制代表了一种针对多种临床适应症的有前途且快速新兴的方法。本文回顾了 FXI 抑制的基本原理、证据、药理学和未来应用。

Anticoagulation is indicated for treatment and prevention of arterial and venous thrombosis. Targeting different steps of the coagulation process, currently available anticoagulants entail an increased risk of bleeding, which detrimentally impacts on prognosis and hinders the administration of an effective antithrombotic regimen. Factor XI (FXI) inhibition has emerged as a strategy to uncouple prevention of thrombosis from bleeding. Indeed, while FXI is crucial for the amplification phase in pathological thrombosis, it is ancillary in physiological hemostasis. A comprehensive search in several scientific databases has been performed to identify relevant studies in the field. In addition, ongoing trials have been searched for in proper datasets to provide an updated and comprehensive assessment of the current state of investigations on FXI inhibition. Many compounds have been tested to inhibit FXI at different stages (i.e., synthesis, activation, or interactions with target molecules and coagulation factors). These include antisense oligonucleotides, monoclonal antibodies, small molecules, natural peptides and aptamers. In phase 2 studies, FXI inhibitors reduced thrombotic complications without any corresponding increase in bleeding. FXI inhibitors were noninferior and potentially superior to low-molecular-weight heparin in orthopedic surgery and reduced bleeding compared to apixaban in patients with atrial fibrillation. FXI inhibition is also under testing in other conditions, including end-stage renal disease, cancer, or noncardioembolic stroke. FXI inhibition represents a promising and rapidly emerging approach for a number of clinical indications. This article reviews the rationale, evidence, pharmacology, and future applications of FXI inhibition.