American Society of Hirudotherapy

Lepirudin

First-generation recombinant hirudin — FDA-approved 1998 for heparin-induced thrombocytopenia (HIT). Withdrawn 2012 by Bayer for commercial reasons.

Studied off-labelLast updated: 2026-05-26 · Reviewed by ASH Editorial Board
Molecular weight of Lepirudin compared with other characterized leech-derived compoundsHementerin80 kDaHementin80 kDaHementin-Like Protein (HLP-1)80 kDaLeech Collagenase70 kDaHaemadipsa yanyuanensis Progr…70 kDaLeech Apyrase67 kDaCalin65 kDaHyaluronidase60 kDaAntithrombin III binding prot…58 kDaCollagenolytic Fibrinolysin55 kDaLeech Thrombospondin-Like Pro…50 kDaLepirudin7 kDa
Molecular weight (kilodaltons) of Lepirudin (highlighted) alongside other characterized leech salivary compounds. Smaller proteins/peptides generally diffuse and act faster.

Mechanistic Evidence Box

Studied off-label
Page type
Compound profile
Evidence type
First-generation recombinant hirudin — FDA-approved 1998 for heparin-induced thrombocytopenia (HIT). Withdrawn 2012 by Bayer for commercial reasons.
Evidence level
FDA-cleared regulatory context
Drug vs leech
Recombinant (genetically expressed)
Safety domains
Bleeding · Allergy / anaphylaxis

Clinical translation limit

Lepirudin is a yeast-expressed recombinant hirudin drug, FDA-approved for HIT until commercial withdrawal in 2012. Its clinical evidence base applies only to the recombinant drug; it does NOT extend to whole medicinal-leech therapy. Lepirudin and whole-leech therapy are separate regulatory products.

Molecular Profile

Category
Anticoagulant
Evidence tier
Tier A — FDA-approved derivative
Molecular weight
6,979 Da
Source species
Recombinant (Saccharomyces cerevisiae expression of hirudin)
Discovered
1986 · Hoechst Marion Roussel / Behringwerke
PDB structures
1HRT
Derived FDA-approved drug
Refludan (FDA approved 1998, withdrawn 2012)
Lepirudin molecular structure

Biological Targets

  • thrombin (Factor IIa)

Key Citations

  1. Greinacher A et al. (1999), Circulation · PMID 10441094
  2. Lubenow N, Greinacher A (2002), Semin Thromb Hemost · PMID 12420238

Related Anticoagulant Compounds

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.