Milvexian with Antiplatelet Therapy after Acute Coronary Syndrome Event.

Milvexian added to antiplatelet therapy after acute coronary syndrome does not significantly reduce major adverse cardiovascular events in high-risk patients.

• Why it matters: Reducing recurrent ischemic events after an acute coronary syndrome is critical, but effective and safe therapies remain limited. Understanding whether milvexian can improve outcomes without increasing bleeding risk addresses an important treatment gap.
• What they did: A phase 3, randomized, placebo-controlled trial enrolled 14,194 patients within 7 days of an acute coronary syndrome, comparing milvexian (25 mg twice daily) plus standard therapy to placebo, with a median follow-up of 12.2 months.
• The result: The trial found no significant difference in the primary efficacy outcome (5.4% vs. 5.1%; hazard ratio 1.05; P=0.50), and bleeding risks were similar between groups, indicating milvexian does not improve cardiovascular outcomes nor increase bleeding risk in this setting.