American Society of Hirudotherapy

Clinical Specialties

Evidence-based review of hirudotherapy across 14 medical disciplines

Last Updated: March 1, 2026Reviewed by: Andrei Dokukin, MD

Hirudotherapy has been applied across a wide range of medical specialties, with evidence quality varying significantly by indication. This section organizes clinical data by medical discipline using a three-tier regulatory classification system.

Three-Tier Classification

Tier A (FDA-Cleared): Venous congestion in microsurgical flap and replantation salvage — the only FDA 510(k)-cleared indication. Tier B (Clinical Evidence): Indications supported by controlled clinical studies but not FDA-cleared. Tier C (Investigational): Applications documented in international clinical literature, primarily case series and expert experience. ASH supports controlled clinical investigation of these applications.

Specialties by Discipline

Tier A/B

Surgery

FDA 510(k)-cleared for venous congestion in microsurgical flap and replantation salvage. 78% salvage rate.

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Tier C

Cardiology

International clinical experience in coronary artery disease, hypertension, and heart failure. Case series data.

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Tier B/C

Dermatology

Wound healing evidence (Tier B) and broader dermatological applications under investigation.

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Tier C

Neurology

Investigational applications in cerebrovascular disease, headache syndromes, and neurological rehabilitation.

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Tier C

Gynecology

International clinical reports in inflammatory and congestive gynecological conditions.

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Tier C

Gastroenterology

Case series data in hepatobiliary and gastrointestinal inflammatory conditions.

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Tier C

Pulmonology

Limited clinical data in pulmonary congestion and inflammatory airway conditions.

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Tier C

Endocrinology

Emerging research in metabolic and endocrine applications.

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Tier C

Urology

International clinical experience in urological inflammatory conditions.

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Tier C

Ophthalmology

Investigational use in glaucoma and orbital congestion.

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Tier C

Dentistry

Limited evidence in oral surgery and perioperative venous congestion.

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Tier C

Otolaryngology

Case reports in ear replantation and flap congestion in ENT surgery.

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Tier C

Pediatrics

Relative contraindication in children under 6. Limited pediatric data with additional safety considerations.

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Tier Mixed

Complete Indications List

Comprehensive catalog of all documented indications with evidence tier classification.

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Related Resources

Clinical Evidence

Systematic reviews across 7 conditions with GRADE framework ratings.

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Safety Protocols

Infection control, bleeding management, and institutional protocols.

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Bioactive Science

The molecular pharmacology underlying clinical applications.

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This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.