Desirudin

Iprivask / Revasc

Desirudin is a recombinant form of hirudin, the natural anticoagulant protein that medicinal leeches use to keep blood from clotting. Produced in yeast, it is a 65-amino-acid polypeptide and a highly specific direct thrombin inhibitor. Like other hirudin-derived agents it binds thrombin — the central clotting enzyme that converts fibrinogen to fibrin — very tightly and directly, occupying both the enzyme's active site and its fibrinogen-recognition region. Because its inhibition is direct, desirudin does not depend on the cofactor antithrombin (as heparin does) and can act on thrombin already incorporated into a clot. Desirudin is given by subcutaneous injection and is approved for the prevention of deep vein thrombosis (DVT) in patients undergoing elective hip-replacement surgery, a setting with a high risk of postoperative clots. Its predictable, weight-independent fixed dosing and subcutaneous route distinguish it from the intravenous, procedure-focused use of bivalirudin. It is cleared largely by the kidneys, so dosing must be reduced and monitored in patients with kidney impairment. Desirudin (Iprivask in the US; Revasc in some regions) is an approved prescription anticoagulant. As with all anticoagulants its principal risk is bleeding, and there is no specific reversal agent, so it is used with appropriate patient selection and monitoring (including of kidney function and, when needed, aPTT). Its availability has varied by market over time. It is a clinician-prescribed medicine used in a defined surgical-prophylaxis setting — not a self-directed, research, or wellness peptide.