Future prospects of prophylaxis for deep vein thrombosis

The last decade has witnessed substantial progress in the prevention and treatment of venous thromboembolism. However, the risk of deep vein thrombosis remains high in trauma patients and those undergoing orthopaedic surgery despite use of the best available prophylaxis. Existing antithrombotics also carry a significant risk of bleeding and other adverse effects, including heparin-induced thrombocytopenia (HIT). More effective and safer anticoagulants are therefore needed. Current approaches for improving the benefit:risk ratio of antithrombotic therapy include the development of indirect thrombin inhibitors with a high anti-Xa:anti-IIa activity ratio, and the use of direct thrombin inhibitors. Novel indirect thrombin inhibitors under investigation include pentasaccharide and the heparinoid danaparoid. These agents may offer reduced bleeding risk compared with conventional therapies, but there is no evidence of greater antithrombotic efficacy. However, due to low cross-reactivity with anti-heparin-platelet factor 4 antibodies, danaparoid and pentasaccharide may prove valuable in the management of HIT. Theoretically, the antithrombotic effect of direct thrombin inhibitors may be greater than that of indirect inhibitors because direct inhibitors are not dependent on endogenous cofactors and are able to inhibit both free and clot-bound thrombin. Direct inhibitors of the active site of thrombin and recombinant variants of hirudin, originally derived from the medicinal leech, are currently under investigation. Early data on lepirudin and desirudin suggest that recombinant hirudins may have clinical applications in thromboprophylaxis for high-risk patients, acute cardiology indications and HIT.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

Review of future DVT prophylaxis: danaparoid and pentasaccharide may help in heparin-induced thrombocytopenia, and the recombinant hirudins lepirudin and desirudin, derived from the medicinal leech, show early promise for high-risk thromboprophylaxis and HIT.

Explore cómo esta investigación se conecta con la práctica clínica

Más estudios revisados por pares en la categoría «Literatura clínica».

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Efectos de la hirudoterapia sobre las funciones hepáticas, el perfil lipídico y la sensibilidad a la insulina en ratas con síndrome metabólico — Bilden A et al. (2026)
• Eficacia y seguridad de la hirudoterapia para mejorar los parámetros de calidad espermática en la infertilidad masculina: un ensayo controlado aleatorizado — Abtahi-Forooshani M et al. (2026)
• Congestión venosa de un colgajo sural reverso manejada con éxito con enoxaparina en un paciente varón con lesión traumática por aplastamiento del pie: un caso clínico — Velasco-Bustamante J et al. (2026)
• Investigación de los efectos terapéuticos del tratamiento con sanguijuelas medicinales sobre la lesión por isquemia-reperfusión de la extremidad inferior — Ünal K et al. (2026)
• Eficacia de la terapia con sanguijuelas medicinales en diversas aplicaciones clínicas: un estudio exhaustivo de Azerbaiyán — Farzali S et al. (2025)
• Hirudoterapia en cirugía reconstructiva: casos clínicos y revisión — Heinz P et al. (2020)
• Hirudoterapia en la cicatrización de heridas — Nair H et al. (2022)
• Hirudoterapia para la isquemia de las extremidades en la unidad de cuidados intensivos pediátricos: una cohorte observacional retrospectiva — Resch J et al. (2022)

Ver toda la investigación analizada por la ASH →