American Society of Hirudotherapy

Lepirudin in the management of heparin-induced thrombocytopenia

Review published in Expert Opinion on Drug Metabolism & Toxicology (2008)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentClinical TrialsGajra A et al. · Expert Opinion on Drug Metabolism & Toxicology, 2008

Abstract

BACKGROUND: Lepirudin is a recombinant hirudin that exerts its anticoagulant effect by direct inhibition of thrombin. Lepirudin is indicated for anticoagulation in patients with heparin-induced thrombocytopenia (HIT) and associated thromboembolic disease to prevent further thromboembolic complications. OBJECTIVE: This review addresses various clinical uses of lepirudin including but not limited to FDA approved indication. The objective is to provide an updated overview of the clinical use and pharmacology of the agent. In addition, we address certain areas of controversy especially pertaining to dosing of lepirudin and its use in different clinical situations. METHODS: Literature was reviewed using appropriate search terms in Pubmed and Ovid medline databases. RESULTS/CONCLUSION: Lepirudin continues to be a valuable anticoagulant in the management of HIT. Lepirudin has the highest recommendation in treatment of HIT based on evidence from clinical trials. Minor modifications in dosing over the standard label recommendations may simplify its use and enhance safety.

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

Publication typeJournal ArticleReview
Indexed MeSH termsAnticoagulantsClinical Trials as TopicDose-Response Relationship, DrugHeparinHirudinsHumansRecombinant ProteinsThrombocytopenia

Summary

Comprehensive pharmacology and clinical review of lepirudin — the recombinant hirudin licensed for HIT with associated thromboembolic disease — covering controversies around bolus dosing and use in renal impairment.

Why This Matters for Hirudotherapy

This review examines the clinical use and pharmacology of lepirudin, a recombinant hirudin that directly inhibits thrombin, in the management of heparin-induced thrombocytopenia (HIT) and associated thromboembolic disease. The abstract states lepirudin is indicated for anticoagulation in patients with HIT to prevent further thromboembolic complications, and notes that it carries the highest recommendation in HIT treatment based on clinical trial evidence, with possible dosing refinements. The article's relevance to ASH's domain is limited: the abstract identifies lepirudin only as 'a recombinant hirudin' and does not mention leeches, leech saliva, leech secretome, or hirudotherapy. CAVEAT: This is a review article summarizing published literature; it provides no new primary data and does not discuss live leech therapy or other bioactive leech constituents.

Citation

Lepirudin in the management of heparin-induced thrombocytopenia.

Gajra A et al. · Expert Opinion on Drug Metabolism & Toxicology, 2008

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

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