Novartis is wagering more than $3 billion that a startup it helped launch six years ago has developed a better blood thinner than whats now available.The Swiss drugmaker on Tuesday announced a deal to acquire Anthos Therapeutics, a Boston-based startup it formed with Blackstone Life Sciences in 2019. Novartis will pay $925 million upfront, and could pay up to $2.15 billion more should the drug at the center of the deal hit certain regulatory and sales milestones. The deal should close in the first half of 2025.Through the acquisition, Novartis will regain a blood-thinning drug, called abelacimab, thats currently in late-stage testing. Novartis originally discovered the compound, but in 2019 licensed it to Anthos, a startup Blackstone Life Sciences launched with $250 million. That deal gave Novartis a minority stake in Anthos, which went on to advance the drug into Phase 3 testing.Abelacimab is a new type of anticoagulant called a Factor XI inhibitor. Its designed to be safer than existing blood thinners like Xarelto and Eliquis, which earn their makers billions of dollars in sales each year. But they also carry bleeding risks that can make treatment challenging. Abelacimab, as well as other Factor XI blockers in development by Bristol Myers Squibb and Regeneron, are thought to stop clotting while sidestepping some of those issues.Testing has yielded inconsistent results, though. Bayer dialed back development of a Factor XI drug after it failed a Phase 3 trial in 2023. Bristol Myers candidate was moved into late-stage trials despite mixed findings in earlier testing. Factor XI blockers have not shown a meaningfully better clinical profile to date than Eliquis or Xarelto in head-to-head Phase 3 trials, RBC Capital Markets analyst Brian Abrahams wrote in December.Generic versions of Eliquis could arrive in 2026, too, raising the commercial bar for alternative therapies to succeed.Still, Anthos acquisition offers another validation for the Factor XI mechanism and its large market potential in the anticoagulant space, Abrahams wrote after the deals announcement Tuesday.Anthos showed a glimpse of that potential in November 2023, when it presented results showing abelacimab was safer than Xarelto in a large, mid-stage trial. Three late-stage studies are ongoing in people at risk of serious clots who have either atrial fibrillation or cancer-associated blood clotting. Anthos has said study results could come next year.We are proud that this medicine originated at Novartis and have been impressed with the Anthos Therapeutics teams expertise and dedication and with the great progress they have made on the program, said David Soergel, head of Novartis cardiovascular, renal and metabolism development unit, in a statement. Now is the right time to bring abelacimab back into the Novartis CRM pipeline.The acquisition is Novartis first of 2025. It adds to a series of startup buyouts inked by Novartis in recent years, including of DTx Pharma, Mariana Oncology, Calypso Biotech and IFM Due. Beyond Novartis, industry dealmaking of late has focused more heavily on privately held companies. '