American Society of Hirudotherapy

Developing an algorithm for treating heparin-induced thrombocytopenia

Review published in Clinical advances in hematology & oncology : H&O (2004)

Last Updated: November 1, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentMcIntosh · Clinical advances in hematology & oncology : H&O, 2004

Abstract

Heparin-induced thrombocytopenia (HIT) is a serious and common complication of heparin therapy that can lead to significant losses of life and limb. It is often under-recognized and, therefore, goes untreated until thrombosis develops. This article is meant to provide specific recommendations for treating patients with immune-mediated HIT, whether or not it is associated with thrombosis. These recommendations are based on our clinical experience treating patients with HIT and our evaluation of the published data on the efficacy and safety of lepirudin and argatroban, the 2 drugs approved by the Food and Drug Administration for treating HIT. Based on these criteria, we consider lepirudin the treatment of choice in all patients with HIT except those with severe or deteriorating renal function.

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

Publication typeJournal ArticleReview
Indexed MeSH termsAlgorithmsAnticoagulantsAntigen-Antibody ComplexArginineClinical Trials as TopicDiagnosis, DifferentialDisease ManagementFollow-Up StudiesHemorrhageHeparinHeparin, Low-Molecular-WeightHirudinsHumansImmunoglobulin GPipecolic AcidsPlatelet ActivationPlatelet CountPlatelet Factor 4PrognosisPurpura, Thrombocytopenic, IdiopathicRecombinant ProteinsSulfonamidesThrombocytopeniaThrombophiliaTime Factors

Summary

The authors offer treatment recommendations for immune-mediated heparin-induced thrombocytopenia based on clinical experience and published data on lepirudin and argatroban, considering lepirudin the treatment of choice except in severe or deteriorating renal function.

Why This Matters for Hirudotherapy

This review outlines an algorithm for managing heparin-induced thrombocytopenia (HIT), focusing on the clinical use of FDA-approved alternative anticoagulants. It specifically highlights lepirudin—a recombinant form of hirudin originally derived from the medicinal leech—as the treatment of choice for most HIT patients. This provides valuable context for the clinical translation of a leech-derived protein into a mainstream pharmaceutical. However, the study does not involve live leeches or natural hirudotherapy; its relevance is strictly limited to the pharmaceutical application of a specific leech-derived molecule.

Citation

Reference (Vancouver style)

McIntosh BA. Developing an algorithm for treating heparin-induced thrombocytopenia. Clin Adv Hematol Oncol. 2004;2(4):216-222. PMID: 16163184

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

Added to ASH library: May 28, 2026 · Site last updated: November 1, 2026

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