Group 1 - The demand for antithrombotic drugs is expanding due to the aging population and rising prevalence of cardiovascular diseases, with the global market size reaching $52.9 billion in 2023 and expected to exceed $110 billion by 2033 [2] - Anticoagulants are the core category within this market, showing steady growth, particularly in China, which provides a broad market foundation for the development and commercialization of new anticoagulants [2] - The upgrade window for anticoagulants has arrived, with the next generation of drugs poised for development as traditional anticoagulants struggle to balance efficacy and bleeding risks [2] Group 2 - FXI is identified as a key target for the next generation of anticoagulants due to its unique advantages of "precise anticoagulation and low bleeding risk," with multiple FXI/FXIa inhibitors currently in registration clinical stages globally [3] - Bayer's Asundexian and BMS/Johnson & Johnson's Milvexian are among the small molecule FXIa inhibitors undergoing clinical trials, with varying degrees of success in different indications [4] - In the realm of monoclonal antibodies, Novartis' Abelacimab has received FDA fast track designation for stroke prevention in atrial fibrillation and cancer-related thrombosis, while Regeneron is advancing two FXI monoclonal antibodies into Phase III trials [4] Group 3 - Recommended companies include Heng Rui Medicine (01276), with related companies being Reblozyl Bio-B (06938) and Jingyin Pharmaceutical [5]

Investment Rating - The report maintains an "Outperform" rating for the industry [1] Core Insights - The global anticoagulant market exceeds $20 billion, primarily driven by stroke prevention in atrial fibrillation patients, with other indications including VTE prevention after knee/hip replacement and prevention of ischemic complications in myocardial infarction [2][5] - FXI/FXIa inhibitors are expected to become safer anticoagulants, as they target the intrinsic pathway of coagulation, potentially reducing bleeding risks while maintaining efficacy [2][21] - Several FXI/FXIa inhibitors are in clinical stages, with promising safety profiles demonstrated in various indications, including Bayer's asundexian achieving key clinical endpoints in secondary stroke prevention [2][26] - FXI small nucleic acid drugs may offer differentiated competitive advantages, with early-stage clinical data showing effective FXI activity suppression and potential for improved patient compliance [2][26] Summary by Sections Anticoagulant Drugs: Applications and Market Size - Anticoagulants are used in various medical scenarios, with a global market size exceeding $20 billion, driven by stroke prevention in atrial fibrillation patients [5][7] - Current anticoagulants include DOACs and low molecular weight heparins, with existing drugs presenting bleeding risks alongside their efficacy [5][21] FXI Inhibitors as Next-Generation Anticoagulants - FXI inhibitors are positioned to challenge standard treatments, with clinical trials indicating superior safety profiles compared to existing DOACs [2][26] - Notably, Bayer's asundexian has shown efficacy in secondary stroke prevention, marking a significant advancement in the field [2][69] Domestic FXI Small Nucleic Acid Drug Development Progress - Domestic companies are advancing in FXI small nucleic acid drug development, with promising early clinical results indicating effective FXI suppression and potential for improved dosing schedules [2][26] Investment Recommendations - FXI/FXIa inhibitors are projected to represent an upgrade and complement to existing anticoagulants, with a potential market space exceeding $10 billion [2][26] - The report suggests focusing on companies like HengRui Medicine, which is leading in domestic FXI monoclonal antibody development [2][26]