Bristol Myers Squibb and Johnson & Johnson suspended a Phase 3 trial of milvexian, a selective factor XIa inhibitor intended as a next‑generation anticoagulant, after an interim analysis showed the study was unlikely to meet its primary endpoint in acute coronary syndrome. The pause closes one path to a potential multibillion‑dollar indication for the molecule. Milvexian remains under evaluation in two other late‑stage trials for atrial fibrillation and secondary stroke prevention; sponsors will reassess the program based on remaining data. The setback underscores persistent clinical risk for factor‑XIa inhibitors despite promising safety and efficacy signals in earlier studies. Developers and investors will now weigh the readouts from the other registrational trials to determine milvexian’s commercial prospects and the broader viability of FXIa as a safer anticoagulation strategy.