Recombinant version of hirudin, the leech anticoagulant. It was approved to prevent venous thrombosis after hip or knee replacement, but today it is no longer marketed in either the US or the EU.
FDA (US): Approved (2003, Iprivask) to prevent deep vein thrombosis after hip replacement; now discontinued in the US
EMA (EU): Withdrawn (approved in 1997 as Revasc to prevent DVT in hip or knee replacement; authorization withdrawn in 2014 for commercial reasons, never marketed)
Dose
15 mg subcutaneously every 12 hours, starting before surgery and continuing for 9–12 days (FDA label, Iprivask).
Safety
Main risk: bleeding (wounds, hematomas). It is eliminated by the kidney, so dose adjustment is required in renal impairment. May generate anti-hirudin antibodies. Hospital use only and under medical supervision.
Interactions
Higher bleeding risk with other anticoagulants, antiplatelets (aspirin, clopidogrel), NSAIDs, or thrombolytics.
Effect by goal · level of evidence
Thrombosis prevention after hip replacement
reducesHighRCT (AA)in people
−40% proximal DVT
In 2,079 patients undergoing hip surgery, desirudin reduced proximal venous thrombosis versus enoxaparin (4.5% vs 7.5%) and total thrombosis (18.4% vs 25.5%), with similar safety.
It binds directly to thrombin, the enzyme that forms the clot, and blocks it without needing antithrombin. This slows fibrin formation and reduces the risk of clots in the veins after orthopedic surgery.
What the evidence says
In people
Prevention of thrombosis after hip replacement. In 2,079 patients undergoing hip surgery, desirudin reduced proximal venous thrombosis versus enoxaparin (4.5% vs 7.5%) and total thrombosis (18.4% vs 25.5%), with similar safety. PubMed 9358126