Desirudin: how it works, uses and side effects

Desirudin inhibits blood clotting and was used to prevent clots in the deep veins of the legs after elective hip replacement. These clots are called deep-vein thromboses. Bleeding is the main risk of treatment. Particular caution is needed with anesthesia near the spinal cord: bleeding in this area can cause paralysis.

What is desirudin?

Desirudin is a genetically engineered form of hirudin and was previously sold under the brand name Iprivask. Hirudin is an anticoagulant protein from medicinal leeches. It keeps blood fluid while the animals feed. Desirudin itself is produced in yeast cells.

The medicine specifically inhibits thrombin, an enzyme involved in blood clotting. It was used to prevent leg clots after orthopedic procedures; the US approval described here concerns elective hip replacement. During development, desirudin carried the code CGP 39393. It was approved in the US in 2003.

How does desirudin work?

Desirudin inhibits thrombin directly. This enzyme acts at the end of the clotting cascade, a sequence of reactions through which blood clots. Thrombin converts fibrinogen into fibrin, which forms a blood clot. It also activates platelets.

Desirudin binds to two sites on thrombin at once: its active site and the site where fibrinogen binds. This blocks the enzyme. Unlike heparin, desirudin does not need the body’s own antithrombin to do this. It also inhibits thrombin already bound within a blood clot.

After hip replacement, restricted mobility and tissue injury from surgery favor the formation of venous clots. In a study of this procedure, confirmed deep-vein thromboses occurred less often with desirudin than with unfractionated heparin. Bleeding did not increase in that study. 1

Desirudin is injected under the skin around the time of surgery. The medical term for this is “subcutaneous.”

Is desirudin FDA-approved?

The US Food and Drug Administration approved desirudin in 2003 to prevent deep-vein thrombosis in people undergoing elective hip replacement. According to the linked drug information, marketing of the only branded product, Iprivask, has been discontinued in the US, and no generic is sold there. Whether this information remains current is unresolved. 2

What was desirudin prescribed for?

Desirudin was prescribed to prevent deep-vein thrombosis after elective hip replacement. Particular caution is needed with spinal or epidural anesthesia. These methods of anesthesia act close to the spinal cord. As with other anticoagulants, bleeding can occur in this area.

What side effects are possible?

Common side effects include:

• Bleeding
• Injection-site reactions
• Anemia and nausea

The following risks and precautions also matter:

• Serious bleeding is the main risk of treatment.
• With spinal or epidural anesthesia, bleeding around the spinal cord can cause paralysis. This warning also applies to other anticoagulants.
• Impaired kidney function requires particular caution. Antibodies against hirudin may also develop.