The use of direct oral anticoagulants for stroke prevention in patients with AFib can cause a risk of bleeding and therefore limits their use. A recent study from the OCEANIC–AF Steering Committee investigated the efficacy of asundexian, an activated factor XI inhibitor that may prevent strokes with less bleeding. In the phase 3, international, double-blind trial, published in the January 2, 2025, issue of NEJM, almost 15,000 high-risk patients with AFib in 38 countries were assigned in a 1:1 ratio to receive asundexian at a dose of 50 mg once daily or standard-dose apixaban.