American Society of Hirudotherapy

The direct thrombin inhibitor hirudin

Research article published in Thrombosis and haemostasis (2008)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentClinical TrialsGreinacher A, Warkentin T · Thrombosis and haemostasis, 2008

Abstract

This review discusses the pharmacology and clinical applications of hirudin, a bivalent direct thrombin inhibitor (DTI). Besides the current major indication for hirudin--anticoagulation of patients with heparin-induced thrombocytopenia (HIT)--the experience with hirudin in other indications, especially acute coronary syndromes, are briefly presented. Hirudins have been formally studied prior to their regulatory approval; however, important information on their side effects and relevant preventative measures only became available later. Therefore, current recommendations and dosing schedules for hirudin differ considerably from the information given in the package inserts. Drawbacks of hirudin and important precautions for avoiding potential adverse effects are discussed in detail in the third part of this review.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsAcute Coronary SyndromeAngioplasty, Balloon, CoronaryAnimalsAnticoagulantsBlood CoagulationBlood Coagulation TestsCardiopulmonary BypassDrug MonitoringFibrinolytic AgentsHemorrhageHemostasis, SurgicalHeparin

Summary

This review discusses the pharmacology and clinical applications of hirudin, a bivalent direct thrombin inhibitor (DTI). Besides the current major indication for hirudin--anticoagulation of patients with heparin-induced thrombocytopenia (HIT)--the experience with hirudin in other indications, especially acute coronary syndromes, are briefly pres...

Why This Matters for Hirudotherapy

This review discusses the pharmacology, clinical indications, and safety of hirudin, a bivalent direct thrombin inhibitor used primarily for anticoagulation in heparin-induced thrombocytopenia (HIT), with additional coverage of acute coronary syndromes, dosing, side effects, and precautions. Hirudin is the molecule for which hirudotherapy is named, making its clinical pharmacology, therapeutic applications, and evolving safety recommendations of direct conceptual relevance to the ASH domain. As a review article, it synthesizes existing literature and post-approval clinical experience rather than presenting new primary data, and the abstract does not address whole-organism leech therapy or the broader leech salivary secretome.

Citation

The direct thrombin inhibitor hirudin.

Greinacher A, Warkentin T · Thrombosis and haemostasis, 2008

DOI

Added to ASH library: March 18, 2026 · Site last updated: June 18, 2026

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