American Society of Hirudotherapy

Lung transplantation using argatroban in severe heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a case series

Research article published in General thoracic and cardiovascular surgery (2020)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportDrug DevelopmentLee et al. · General thoracic and cardiovascular surgery, 2020

Abstract

Lung transplantation during heparin-induced thrombocytopenia (HIT) is controversial and often considered a contraindication because of the risk of increased bleeding and thrombosis in the recipient. Although lung transplantation offers the best chance for cure in end-stage lung disease, the outcome after transplantation is still controversial in patients with HIT. In our center, two patients developed HIT type II during venovenous extracorporeal membrane oxygenation (ECMO) support for acute respiratory failure. They underwent successful lung transplantation using argatroban. The subsequent clinical course was uneventful except evacuation of post-operative hematoma in 1 patient, and they were discharged. Argatroban was successfully used during lung transplant surgery in patients who developed HIT type II during ECMO support. Further studies on the feasibility and safety of lung transplantation using a direct thrombin inhibitor in patients with HIT during ECMO are required.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAnticoagulantsArginineExtracorporeal Membrane OxygenationHeparinHumansLung TransplantationPipecolic AcidsSulfonamidesThrombocytopenia

Summary

Peer-reviewed research on anticoagulant and antithrombotic agents relevant to leech-derived compounds and thrombosis management. Indexed in PubMed and verified against the NCBI record.

Why This Matters for Hirudotherapy

This case series describes two patients who developed heparin-induced thrombocytopenia (HIT) type II during venovenous ECMO support for acute respiratory failure and then underwent successful lung transplantation anticoagulated with argatroban, a direct thrombin inhibitor, with an uneventful course aside from one post-operative hematoma evacuation. The connection to ASH's drug-discovery story is mechanistic: the medicinal-leech secretome is the origin of hirudin and modern direct thrombin inhibitors, and this report illustrates how thrombin inhibition serves as a heparin alternative in high-stakes surgery where heparin is contraindicated. The caveat is substantial: this is a two-patient case series describing argatroban (a synthetic agent), not leech therapy or leech-derived hirudin, and the authors explicitly call for further studies on feasibility and safety, so it offers only anecdotal, hypothesis-generating support for the thrombin-inhibitor class.

Citation

Lung transplantation using argatroban in severe heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a case series.

Lee et al. · General thoracic and cardiovascular surgery, 2020

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

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.