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A new approach to anticoagulant therapy: abelacimab and the EKOS ultrasonic endovascular thrombectomy system

https://doi.org/10.30629/0023-2149-2026-104-6-417-423

Abstract

The article focuses on new approaches to anticoagulation: abelacimab, a modern, highly selective factor XI inhibitor, and the Boston Scientifi c EKOS minimally invasive clot dissolution system. This paper analyzes the unique mechanisms of action of abelacimab, revealing its therapeutic potential compared to traditional anticoagulants, and its potential applications in clinical practice. The drug's pharmacokinetic properties are discussed in detail, particularly its rapid onset of action (within 30 minutes) and exceptional duration of action (over 30 days). Particular attention is paid to the clinical indications for abelacimab, as well as its pharmacokinetic characteristics and administration routes, which are important aspects for its practical application. The second part of the article discusses the potential use of the Boston Scientifi c EKOS ultrasound endovascular thrombectomy system for minimally invasive thrombolysis, which can be combined with the eff ectiveness of abelacimab. A clinical example of the successful use of the EKOS system in a patient with occlusive deep vein thrombosis of the lower extremity is presented. 

About the Authors

V. N. Ardashev
Clinical Hospital No. 1 of the Administrative Directorate of the President of the Russian Federation
Russian Federation

Vyacheslav N. Ardashev — Doctor of Medical Sciences, Professor, Scientifi c Director of Therapy

Moscow



V. M. Frolov
Main Production and Commercial Directorate for Servicing the Diplomatic Corps of the Ministry of Foreign Aff airs of the Russian Federation, MedinCenter Branch
Russian Federation

Victor M. Frolov — Candidate of Medical Sciences, Associate Professor, Functional Diagnostics Physician

Moscow



E. M. Novikov
Clinical Hospital No. 1 of the Administrative Directorate of the President of the Russian Federation; Main Production and Commercial Directorate for Servicing the Diplomatic Corps of the Ministry of Foreign Aff airs of the Russian Federation, MedinCenter Branch
Russian Federation

Egor M. Novikov — Candidate of Medical Sciences, Head of the Cardiology Department; cardiologist

Moscow



M. M. Stepanov
Clinical Hospital No. 1 of the Administrative Directorate of the President of the Russian Federation
Russian Federation

Maxim M. Stepanov — Candidate of Medical Sciences, Head of the Cardiology Department No. 2

Moscow



E. I. Myasoedova
Main Production and Commercial Directorate for Servicing the Diplomatic Corps of the Ministry of Foreign Aff airs of the Russian Federation, MedinCenter Branch
Russian Federation

Ekaterina I. Myasoedova — Doctor of Medical Sciences, Deputy Chief Physician for Clinical and Expert Work, Ultrasound Diagnostics Doctor

Moscow



V. V. Dordjieva
Main Production and Commercial Directorate for Servicing the Diplomatic Corps of the Ministry of Foreign Aff airs of the Russian Federation, MedinCenter Branch; I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russia (Sechenov University)
Russian Federation

Victoria V. Dordjieva — 5th-year student; a nurse 

Moscow



E. A. Gerasimenko
Main Production and Commercial Directorate for Servicing the Diplomatic Corps of the Ministry of Foreign Aff airs of the Russian Federation, MedinCenter Branch; I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russia (Sechenov University)
Russian Federation

Ekaterina A. Gerasimenko — 5th-year student; nurse

Moscow



I. V. Globa
I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russia (Sechenov University)
Russian Federation

Irina V. Globa — Candidate of Medical Sciences, Assistant Professor at the Department of Forensic Medicine 

Moscow



References

1. Zolkin V.N., Tishchenko I.S. Anticoagulant therapy in the treatment of acute thrombosis of deep and superfi cial veins of the lower extremities. Diffi cult patient. 2007;5(15–16):11 –15. (In Russ.)].

2. Raffo C., Capodanno D. Factor XI inhibition in patients with acute coronary syndrome. European Heart Journal Supplements. 2024;26(1):i29-i34. DOI: 10.1093/eurheartjsupp/suae013

3. Ortel T.L., Neumann I., Ageno W., Beyth R., Clark N.P., Cuker A. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood advances. 2020;4(19):4693–4738. DOI:10.1182/bloodadvances.2020001830

4. Abraham N.S., Noseworthy P.A., YaoX., Sangaralingham L.R., Shah N.D. Gastrointestinal safety of direct oral anticoagulants: a large population-based study. Gastroenterology. 2017;152(5):1014– 1022. e1. DOI: 10.1053/j.gastro.2016.12.018

5. Moroz E.V., Karateev A.E., Kryukov E.V., Chernetsov V.A. Gastrointestinal bleeding with the use of new oral anticoagulants: epidemiology, risk factors, treatment and prevention. Scientifi c and practical rheumatology. 2017;55(6):675–684. (In Russ.)]. DOI: 10.14412/1995-4484-2017-675-684

6. Vorobyova N.M., Malaya I.P., Lelkova A.M., Tkacheva O.N. Possibilities of gastrointestinal tract protection when using direct-acting oral anticoagulants in patients with atrial fi brillation. Clinical analysis in general medicine. 2022(3):43–49. (In Russ.)]. DOI: 10.47407/kr2022.3.3.00133

7. Barnes G.D. New targets for antithrombotic medications: Seeking to decouple thrombosis from hemostasis. Journal of Thrombosis and Haemostasis. 2024. DOI: 10.1016/j.jtha.2024.12.003

8. Carlin S. Jakovac M., Budaj A., Eikelboom J. Factor XI inhibition in cardiovascular disease. Polish Archives of Internal Medicine. 2024;134(7–8):16799–16799. DOI: 10.20452/pamw.16799

9. Nolte C.H. Factor XI inhibitors–Rising stars in anti-thrombotic therapy?. Journal of the Neurological Sciences. 2024;464:123157. DOI: 10.1016/j.jns.2024.123157

10. Gailani D. Making anticoagulation safer. The Lancet. 2022; 399(10333):1360–1361. DOI: 10.1016/S0140-6736(22)00563-3

11. Merkulova, I. P. Pathophysiology of the blood system: a teaching aid. I.P. Merkulova. 2nd ed. Minsk: Moscow State University of Economics and Finance, 2012:120. (In Russ.)].

12. Analeev A.I., Semitko S.P., Chernysheva I.E., Belikov N.V., Khaidukova I.V., Borde A.S. et al. Ultrasound-assisted intravascular therapy: history of the issue and development prospects. Consilium Medicum. 2024;26(1):12–19. (In Russ.)]. DOI: 10.26442/20751753.2024.1.202586

13. Ferri N., Colombo E., Corsini A. Drug–drug interactions of FXI inhibitors: clinical relevance. Hematology reports. 2024;16(1):151–163. DOI: 10.3390/hematolrep16010016

14. Fioretti A.M., Leopizzi T., La Forgia D., De Luca R., Oreste D., Inchingolo R. et al. Abelacimab in cancer-associated thrombosis: the right drug at the right time for the right purpose. A comprehensive review. Reviews in Cardiovascular Medicine. 2023;24(10):295. DOI: 10.31083/j.rcm2410295

15. Yi B.A., Freedholm D., Widener N., Wang X., Simard E., Cullen C. et al. Pharmacokinetics and pharmacodynamics of Abelacimab (MAA868), a novel dual inhibitor of Factor XI and Factor XIa. Journal of Thrombosis and Haemostasis. 2022;20(2):307–315. DOI:10.1111/jth.15577

16. Bitsadze V.O., Slukhanchuk E.V., Khizroeva D.Kh., Tretyakova M.V., Tsibizova V.I., Gashimova N.R. et al. Anticoagulants: dose control methods and inhibitors. Obstetrics, Gynecology and Reproduction. 2022;16(2):158–175. (In Russ.)]. DOI: 10.17749/2313-7347/ob.gyn.rep.2022.293

17. Yakovleva D.R., Stepchenko M.A., Meshcherina N.S. Genetically engineered biological drugs: a window of opportunity in cardiology practice. Cardiology: News. Opinions. Training. 2024;12(4 (39)):66–74. (In Russ.)]. DOI: 10.33029/2309-1908-2024-12-4-66-74

18. Keizer R.J., Huitema A.D., Schellens J.H., Beijnen J.H. Clinical pharmacokinetics of therapeutic monoclonal antibodies. Clinical pharmacokinetics. 2010;49(8):493–507. DOI: 10.2165/11531280-000000000-00000

19. Campello E., Simioni P., Prandoni P., Ferri N. Clinical pharmacology of factor XI inhibitors: new therapeutic approaches for prevention of venous and arterial thrombotic disorders. Journal of clinical medicine. 2022;11(21):6314. DOI:10.3390/jcm11216314

20. Occhipinti G., Laudani C., Spagnolo M., Finocchiaro S., Mazzone P.M., Faro D.C. et al. Pharmacological and clinical appraisal of factor XI inhibitor drugs. European Heart Journal-Cardiovascular Pharmacotherapy. 2024;10(3):245–258. DOI: 10.1093/ehjcvp/pvae002

21. Verhamme P., Yi B.A., Segers A., Salter J., Bloomfi eld D., Büller H.R. et al. Abelacimab for prevention of venous thromboembolism. New England Journal of Medicine. 2021;385(7):609–617. DOI:10.1056/NEJMoa2105872

22. Żuk-Łapan A., Jakubik O., Pałuchowski M., Gajewska M., Rogula S., Łomiak M., Gąsecka A. Targeting factor XI as a compromise between thrombosis and bleeding. Cardiology Journal. 2025. DOI: 10.5603/cj.102145

23. Raff o C., Di Leo G., Capodanno D. Factor XI inhibitors and atrial fi brillation: imminent breakthrough or false start? European Heart Journal Supplements. 2025;27(3):iii46–iii53. DOI: 10.1093/eurheartjsupp/suaf015

24. Ruff C.T., Patel S.M., Giugliano R.P., Morrow D.A., Hug B., Kuder J.F. et al. Abelacimab versus rivaroxaban in patients with atrial fi brillation. New England Journal of Medicine. 2025;392(4):361–371. DOI: 10.1056/NEJMoa2406674

25. Grafeneder J., Langer G., Schoergenhofer C., Eskandary F., Jilma B., Khder Y., Kovacevic Miljevic K.D. The factor XI/XIa anti body abelacimab combined with enoxaparin inhibits fi lter clotting in hemodialysis circuits ex vivo. Journal of Thrombosis and Thrombolysis. 2024;57(8):1339–1348. DOI: 10.1007/s11239-024-03059-x

26. Siegel R.J., Luo H. Ultrasound thrombolysis. Ultrasonics. 2008;48(4):312–320. DOI: 10.1016/j.ultras.2008.03.010

27. Rosenschein U., Roth A., Rassin T., Basan S., Laniado S., Miller H. I. Analysis of coronary ultrasound thrombolysis endpoints in acute myocardial infarction (ACUTE trial) Results of the feasibility phase. Circulation. 1997;95(6):1411–1416. DOI: 10.1161/01.cir.95.6.1411

28. Piazza G., Hohlfelder B., Jaff M.R., Ouriel K., Engelhardt T.C., Sterling K.M. et al. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fi brinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. Cardiovascular Interventions. 2015;8(10):1382–1392 DOI: 10.1016/j.jcin.2015.04.020

29. Ouriel K., Veith F.J., Sasahara A.A. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. New England Journal of Medicine. 1998;338(16):1105–1111. DOI: 10.1056/NEJM199804163381603

30. Wissgott C., Richter A., Kamusella P., Steinkamp H. J. Treatment of critical limb ischemia using ultrasound-enhanced thrombolysis (PARES Trial): fi nal results. Journal of Endovascular Therapy. 2007;14(4):438–443. DOI: 10.1177/152660280701400402

31. Kucher N., Boekstegers P., Müller O.J., Kupatt C., Beyer-Westendorf J., Heitzer T. et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation. 2014;129(4):479–486. DOI: 10.1161/CIRCULATIONAHA.113.005544

32. Tapson V.F., Sterling K., Jones N., Elder M., Tripathy U., Brower J. et al. A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial. JACC: Cardiovascular Interventions. 2018;11(14):1401–1410. DOI: 10.1016/j.jcin.2018.04.008

33. Sterling K.M., Goldhaber S.Z., Sharp A.S.P., Kucher N., Jones N., Maholic R. et al. Prospective multicenter international registry of ultrasound-facilitated catheter-directed thrombolysis in intermediate- high and high-risk pulmonary embolism (KNOCOUT PE). Circulation: Cardiovascular Interventions. 2024;17(3):e013448. DOI: 10.1161/CIRCINTERVENTIONS.123.013448

34. Klok F.A., Piazza G., Sharp A.S., Ainle F.N., Jaff M.R., Chauhan N. et al. Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study. American heart journal. 2022;(251):43–53. DOI: 10.1016/j.ahj.2022.05.011

35. Marmagkiolis K., Lendel V., Cilingiroglu M. EKOS™ ultrasound–accelerated catheter–directed thrombolysis for acutely occluded femoro-popliteal graft. Cardiovascular Revascularization Medicine. 2014;15(1):43–45. DOI: 10.1016/j.carrev.2013.12.001

36. Pinsdorf D., Messiha D., Knuschke R., Petrikhovich O., Lortz J., Jánosi R. A., Rassaf T., Rammos C. Comparison of ultrasoundassisted thrombolysis and mechanical thrombectomy in intermediatehigh-risk pulmonary embolism. Vasa. 2025;54(6):406–413. DOI: 10.1024/0301-1526/a001180

37. Robles K.E., Armbruster A.L., Austin S.E., Baker J.N. Utilization of EKOS in patients with pulmonary embolism. Innovations. 2022;17(1):30–36. DOI: 10.1177/15569845211057882


Review

For citations:


Ardashev V.N., Frolov V.M., Novikov E.M., Stepanov M.M., Myasoedova E.I., Dordjieva V.V., Gerasimenko E.A., Globa I.V. A new approach to anticoagulant therapy: abelacimab and the EKOS ultrasonic endovascular thrombectomy system. Clinical Medicine (Russian Journal). 2026;104(6):417–423. (In Russ.) https://doi.org/10.30629/0023-2149-2026-104-6-417-423

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ISSN 0023-2149 (Print)
ISSN 2412-1339 (Online)