Desirudin

Desirudin, formerly Iprivask, is a yeast-produced version of the leech anticoagulant hirudin rather than a leech extract. Developed as CGP39393, it received US approval in 2003 for postoperative venous-clot prevention.

Desirudin binds thrombin at both its catalytic site and fibrinogen-binding region, blocking conversion of fibrinogen to fibrin and further platelet activation. It does not need antithrombin and can inhibit thrombin already bound within a clot.

In elective hip replacement, the pivotal study found fewer confirmed deep-vein thromboses than with unfractionated heparin without greater bleeding in that trial. Subcutaneous perioperative administration addressed clot risk from immobility and surgical injury; the favorable comparison does not eliminate bleeding risk.

FDA approval in 2003 covered DVT prevention after elective hip replacement. Iprivask, the only US brand, was subsequently discontinued and no generic is described. The former prescribing role must be distinguished from current product supply.

Spinal or epidural anesthesia requires particular anticoagulant precautions because bleeding around the spine can cause neurological injury.

Bleeding, injection-site reactions, anemia and nausea are common effects. Hemorrhage is the main serious risk. Neuraxial procedures can lead to spinal bleeding and paralysis; kidney impairment and possible antihirudin antibodies are additional concerns.