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Next-Gen Anticoagulant Lands FDA Nod for Secondary Stroke Prevention

The first-in-class pill cut recurrent ischemic stroke risk by 26% in a Phase 3 trial, with similar major bleeding rates, the company said.

  • On Monday, the Food and Drug Administration approved Bayer's Sunharbo 50 mg tablets, the first Factor XIa inhibitor for reducing recurrent stroke risk in adults following mild-to-moderate ischemic stroke or high-risk transient ischemic attack.
  • Unlike existing blood thinners blocking Factor Xa, such as Xarelto, Sunharbo inhibits Factor XIa, a protein that amplifies coagulation cascades; this mechanism prevents clot formation while reducing bleeding risks associated with many current treatments.
  • In the OCEANIC-STROKE study of 12,327 adults, Sunharbo 50 mg tablets reduced ischemic stroke risk by 26% compared to placebo over a median 14.2 months, with 6.2% of treated patients experiencing secondary strokes versus 8.4% in the placebo group.
  • A 30-day supply of Sunharbo will have a list price of $748.50, and stroke neurologists will be a very important part of the drug's early rollout, said Sebastian Guth, chief operating officer of Bayer Pharmaceuticals and president of Bayer U.S.
  • Bayer expects Sunharbo to offset declining revenue from older medicines like Xarelto, though future competition includes therapies from Novartis and a joint effort by Bristol Myers Squibb and Johnson & Johnson currently in clinical development.
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Reuters broke the news in London, United Kingdom on Monday, November 9, 2026.
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