American Society of Hirudotherapy

New anticoagulants.

Review published in American heart journal (2001)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentSalivary PharmacologyHirsh · American heart journal, 2001

Abstract

BACKGROUND: Heparin and coumarins have been in clinical use for more than 50 years. Low-molecular-weight heparins (including a heparinoid), developed 25 years ago, have been used clinically for more than a decade. METHODS: In the last 10 years, several new anticoagulants that target almost every step in the coagulation pathway have been developed. Of these, 3 direct thrombin inhibitors (hirudin, bivalirudin, and argatroban) are approved for clinical use. Four other anticoagulants (activated protein C, tissue factor pathway inhibitor, synthetic pentasaccharide, and the oral thrombin inhibitor H376/95) are being evaluated or have completed evaluation in phase III studies; various other compounds are in phase II studies. RESULTS: The mechanism of action, sites of action, and potential clinical indications of these new anticoagulants are reviewed. CONCLUSIONS: To compete effectively, the new oral anticoagulants currently under development will have to be at least as effective and safe as coumarins, oral thrombin, or Factor Xa inhibitors and require less monitoring.

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

Publication typeJournal ArticleReview
Indexed MeSH termsAnticoagulantsAntithrombinsBlood CoagulationClinical Trials as TopicDrugs, InvestigationalHumans

Summary

Heparin and coumarins have been in clinical use for more than 50 years. Low-molecular-weight heparins (including a heparinoid), developed 25 years ago, have been used clinically for more than a decade.

Why This Matters for Hirudotherapy

This review surveys the development of new anticoagulant drugs targeting nearly every step in the coagulation pathway, detailing their mechanisms of action, sites of action, and potential clinical indications. The abstract identifies hirudin—alongside bivalirudin and argatroban—as one of three direct thrombin inhibitors already approved for clinical use. For ASH's domain, the explicit naming of hirudin as an established clinical anticoagulant confirms its recognized place within the broader anticoagulant pharmacopoeia. However, the article's scope is extremely broad, covering various systemic pharmaceutical agents, and the abstract does not discuss hirudotherapy, live leech application, the leech secretome, or the biological origin of hirudin.

Citation

New anticoagulants.

Hirsh · American heart journal, 2001

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.