Milvexian is being developed as an oral anticoagulant for the prevention and treatment of thrombotic diseases. It works by inhibiting Factor XIa, a key component in the blood coagulation cascade, which plays a role in clot formation but appears to have less impact on normal hemostasis. This mechanism offers the potential for effective prevention of blood clots with a reduced risk of bleeding compared to traditional anticoagulants. It is under investigation for use in conditions such as stroke prevention in atrial fibrillation, secondary prevention of acute coronary syndrome, and prevention of venous thromboembolism, especially in patients undergoing orthopedic surgery. Because of its targeted action, Milvexian may provide a safer alternative in long-term anticoagulation therapy where bleeding risk is a major concern. Clinical trials are ongoing to evaluate its efficacy and safety profile across different patient populations.