Desirudin
Direct thrombin inhibitor
Also Iprivask, Revasc, Recombinant hirudin, r-hirudin
- Evidence
- AStrong human evidence
- FDA status
- FDA approvedas of 2026-10-26
- Route
- Injection
- Studies cited
- 2 human0 animal or cell
It is a blood thinner that was given after hip replacement surgery to stop clots. A trial of 2,079 patients showed fewer clots than with another blood thinner, but it is no longer sold in the US.
Sold for
Desirudin has no consumer following; it is a footnote in anticoagulation, a leech-derived thrombin blocker that beat enoxaparin in a large trial and then disappeared from the market for commercial reasons.
Studies say
A 2,079-patient randomized trial showed desirudin prevented more clots after hip replacement than enoxaparin with similar bleeding, which earns an A for the approved use even though the product is no longer sold.
Why grade A. Approval rested on randomized double-blind trials in hip replacement. The larger one randomized 2,079 patients across 31 European centres and found fewer proximal deep vein thromboses with desirudin (4.5%) than with enoxaparin (7.5%), with venography confirming every diagnosis; a 445-patient trial found a larger advantage over unfractionated heparin. 13
FDA. Desirudin was FDA-approved in 2003 as Iprivask for preventing deep vein thrombosis in patients undergoing elective hip replacement. Iprivask has been discontinued in the United States and no generic is sold, so the approval stands but no product is available. 2
Written from 3 cited sources. Fact-checked 2026-10-27: 13 claims checked, 2 corrected. Last refreshed 2026-10-27. Not physician reviewed.
What this means for you
- What people take it for
- Preventing blood clots after hip surgery
- Can a US doctor prescribe it?
- Yes, FDA approved for preventing leg clots after hip replacement, but it is no longer sold in the US.
- Properly tested in people?
- Yes, in large controlled trials, including one of 2,079 patients.
Evidence checklist
- Randomised controlled trial Double-blind vs enoxaparin after hip surgeryyes
- Human study over 100 people 2,079 hip replacement patientsyes
- More than one research group One main trial plus earlier heparin trialno
- Clinical outcomes, not surrogate markers Venography-confirmed clotsyes
- Human safety data beyond case reports Bleeding and antibodies tracked in trialsyes
Drawn from the cited studies below. A dash means the sources give no information.
What it is
Desirudin is a lab-made version of hirudin. Hirudin is a protein with 65 amino acids that thins blood. It comes from the saliva of the medicinal leech Hirudo medicinalis. Desirudin lacks a sulphate group on one tyrosine, and yeast makes it. Doctors gave it by injection under the skin, starting shortly before hip surgery. 2
Iprivask won approval in 2003, and the FDA listing remains. But the product has been off the US market for several years. It was never a high-volume drug. Low-molecular-weight heparins cost less and were more familiar. 2
How it works
Desirudin is a direct thrombin inhibitor. Thrombin is the enzyme that turns fibrinogen into the fibrin threads of a clot. Desirudin binds thrombin at two sites at once and blocks it. It does not need antithrombin, the helper that heparins depend on. It also does not bind platelet factor 4. So it does not cause heparin-induced thrombocytopenia. And it keeps working against thrombin already trapped in a clot. Bivalirudin works the same way. It is a shorter lab-made hirudin fragment used during heart procedures. 21
What human research shows
Eriksson and colleagues randomized 2,079 patients having planned total hip replacement. They worked at 31 centres in 10 countries. Patients got desirudin or enoxaparin for 8 to 12 days. At the end, venography of both legs looked for clots. In the 1,587 patients with usable venograms, deep vein thrombosis near the hip occurred in 4.5% on desirudin and 7.5% on enoxaparin. That is a 40% relative drop. Any deep vein thrombosis occurred in 18.4% against 25.5%. Safety, including bleeding, was similar in the two groups. 1
An earlier double-blind trial randomized 445 hip replacement patients to desirudin or unfractionated heparin. Among the 351 with adequate venograms, deep vein thrombosis occurred in 7% on desirudin and 23% on heparin. Clots near the hip occurred in 3% against 16%. Bleeding did not differ. 3
| Study | Model | Finding |
|---|---|---|
| Eriksson 1997, desirudin vs enoxaparin | Humans, n=2,079 elective hip replacement, randomized double-blind, venography-confirmed | Proximal DVT 4.5% versus 7.5%; any DVT 18.4% versus 25.5%; similar bleeding. 1 |
| Eriksson 1997, desirudin vs heparin | Humans, n=445 elective hip replacement, randomized double-blind, venography-confirmed | Deep vein thrombosis 7% versus 23%; proximal clots 3% versus 16%; no difference in bleeding. 3 |
| Iprivask prescribing information | Regulatory summary of two randomized trials | Approved for DVT prevention in hip replacement; product since discontinued. 2 |
Safety
Bleeding is the main risk, as with any blood thinner. In the enoxaparin comparison, the rates were equal. The kidney clears desirudin. In people with poor kidney function it builds up. They need a lower dose and monitoring of the activated partial thromboplastin time. Hirudin is a foreign protein. Some patients made antibodies to it. Rare cases of anaphylaxis followed a second exposure. That is why the label urges caution in anyone who has had hirudin before. The label also carries a class warning about spinal or epidural haematoma. This risk applies when numbing injections near the spine are used with blood thinners. 21
Questions for your clinician
- Which clot-prevention options are actually available to me after surgery?
- Do my kidneys change which blood thinner is appropriate?
- Have I ever received a leech-derived drug before?
Questions people ask
Is desirudin FDA-approved?
Yes, since 2003, for preventing deep vein thrombosis after planned hip replacement. The only brand, Iprivask, has been discontinued in the United States. No generic exists, so you cannot get it. 2
Why was it discontinued if it beat enoxaparin?
The sources give no stated reason. Low-molecular-weight heparins cost less and were already standard. Newer oral blood thinners then arrived for the same approved use. That left little room to sell it. 2
Does it cause heparin-induced thrombocytopenia?
No. Desirudin blocks thrombin directly. It does not bind platelet factor 4, the trigger for that immune reaction. The similar concern with hirudins is antibodies against the leech protein itself. 2
Is it the same as bivalirudin?
Related but not the same. Bivalirudin is a lab-made peptide with 20 amino acids, modelled on part of hirudin. Doctors give it into a vein during heart procedures. Desirudin is the nearly complete 65-amino-acid protein, made by recombinant methods. Doctors give it under the skin to prevent clots after surgery. 2
Citations
- Eriksson 1997, N Engl J Med: recombinant hirudin (desirudin) versus enoxaparin to prevent thromboembolism after total hip replacement pubmed.ncbi.nlm.nih.gov
- Drugs.com: Iprivask (desirudin), discontinued drugs.com
- Eriksson 1997, J Bone Joint Surg Am: desirudin versus unfractionated heparin after total hip replacement doi.org