Desirudin

Summary

Desirudin (Iprivask) is a recombinant DNA-derived hirudin analog approved for prophylaxis of deep vein thrombosis (DVT) in patients undergoing elective hip replacement surgery. It is a 65-amino-acid polypeptide that differs from natural hirudin by lacking sulfation at Tyr63. It directly inhibits thrombin independently of antithrombin III.

Mechanism of Action

Desirudin is a recombinant hirudin variant that directly and specifically inhibits free and clot-bound thrombin (factor IIa) by forming a 1:1 stoichiometric complex, blocking thrombin's catalytic site and preventing fibrin formation, platelet activation, and coagulation cascade amplification.

Routes of Administration

Goals & Uses

• Acute coronary syndrome anticoagulationAnticoagulationLow
• Prevention of pulmonary embolismAnticoagulationModerate
• Heparin-induced thrombocytopenia (HIT) anticoagulationAnticoagulationModerate
• DVT prophylaxis after hip replacementAnticoagulation / ThromboprophylaxisHigh

Contraindications

• Spinal/epidural anesthesia with concurrent anticoagulant useAnestheticHigh
• Hypersensitivity to hirudins or desirudinImmunologicHigh
• Severe renal impairment (CrCl <31 mL/min)RenalHigh
• Irreversible coagulation disordersHematologicHigh
• Active bleeding or hemorrhagic diathesisHematologicHigh

Adverse Effects

• Hypersensitivity / allergic reactionsImmunologicRare
• Injection site reactionsLocalCommon
• Bleeding (major and minor)HematologicalCommon
• AnemiaHematologicCommonLow red blood cell count or hemoglobin
• Thrombosis (paradoxical)VascularRare
• NauseaGastrointestinalUncommonFeeling of sickness or urge to vomit

Drug Interactions

• DextranModerate
• Heparin / Low-molecular-weight heparinsHigh
• WarfarinHigh
• NSAIDs / Antiplatelet agents (e.g., aspirin, clopidogrel)Moderate
• Thrombolytics (e.g., alteplase)High

Population Constraints

• Pregnancy (Category C)ReproductiveRelative
• Hepatic impairmentOrgan FunctionRelative
• Renal impairment (moderate to severe)RenalAbsolute
• Elderly patientsAgeRelative
• Patients with prior hirudin exposureImmunologicRelative

Regulatory Status

• European UnionApprovedApproved: Prevention of deep vein thrombosis in patients undergoing elective hip replacement surgeryApproved in the EU under the brand name Revasc; availability may vary by country
• United StatesApprovedApproved: Prophylaxis of deep vein thrombosis in patients undergoing elective hip replacement surgeryApproved by FDA in 2003 under the brand name Iprivask; manufacturing discontinued circa 2012; no longer commercially available in the US market
• United KingdomApprovedApproved: Prophylaxis of deep vein thrombosis following hip replacement surgeryPreviously available under Revasc brand; current commercial availability subject to change post-Brexit

FDA-approved in 2003 for DVT prophylaxis in hip replacement surgery. Manufacturing was discontinued in the US around 2012; the product is no longer commercially available in the US but has been approved in the EU.

Evidence & Sources

No sources recorded yet.