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Case 3.10
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
How does leeching work?There are more than 600 leech species, but Hirudo medicinalis is the most frequently applied.Their primary effect is to reduce congestion by feeding on blood, with 10–15 ml digested during a 40-minute feed. This is aided by other actions such as:vasodilation: caused by secreted Histamine-like molecules and acetylcholine,an anticoagulant effect: caused by the secretion of hirudin – which is a thrombin inhibitor, and antistasin – which is a factor Xa inhibitor, as well asan antiplatelet effect: caused by various secreted proteins which decrease platelet aggregation and thromboxane production.However, it is important to:cover for Aeromonas that is present in their gut and is essential for blood digestion, with broad-spectrum antibiotics such as ciprofloxacin or co-amoxiclav, as well asmonitor Hb levels daily.
Animal Source Foods
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Since the time of Hippocrates, bloodletting has been a popular remedy, and leeches (Hirudo medicinalis) played a key role. They became especially popular in the 1800s, when France and many other countries imported millions of leeches each year for medical purposes. Although the practice of bloodletting has been largely abandoned by Western medicine, leeches have nonetheless continued to be useful (170). Recently, extensive research on leech saliva unveiled the presence of a variety of bioactive peptides and proteins involving antithrombin (hirudin, bufrudin), antiplatelet (calin, saratin), factor Xa inhibitors (lefaxin), antibacterial (theromacin, theromyzin), and others. Consequently, leech has made a comeback as a new remedy for many chronic and life-threatening abnormalities, such as cardiovascular problems, diabetes mellitus, cancer, metastasis, and infectious diseases (174). In the twentieth century, leech therapy has established itself in plastic and microsurgery as a protective tool against venous congestion, and serves to salvage replanted digits (fingers, toes) and flaps (skin grafts). Many clinics for plastic surgery all over the world have begun to use leeches for cosmetic purposes (174). Leeches are also being used directly to preserve the viability of tissue grafts in the presence of significant vascular congestion. Despite the efficacious properties of leech therapy, the safety and complications of leeching are still controversial.
General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Leeches are annelid worms with ‘V’-shaped mouth parts. Their three jaws, each with >100 teeth, form a ‘Mercedes Benz symbol’ shape. Hirudo medicinalis is one of more than 700 species of annelids.
Hirudin versus citrate as an anticoagulant for ROTEM platelet whole blood impedance aggregometry in thrombocytopenic patients
Published in Platelets, 2023
Wasanthi Wickramasinghe, Bhawani Yasassri Alvitigala, Thisarika Perera, Panduka Karunanayake, Saroj Jayasinghe, Senaka Rajapakse, Praveen Weeratunga, Ananda Wijewickrama, Roopen Arya, Klaus Goerlinger, Lallindra Viranjan Gooneratne
Platelets play a crucial role in hemostasis.1 The rotational thromboelastometry (ROTEM) platelet module used together with the ROTEM delta device (TEM Innovations GmbH, Munich, Germany) assesses platelet aggregation by whole blood impedance aggregometry and displays platelet aggregation graphically and numerically.2 3.2% sodium citrate is the most widely used and conveniently available anticoagulant for platelet function tests (PFTs), although its chelation of ionized calcium in blood affects platelet function by the inhibition of platelet aggregation since intra-platelet calcium concentration is an important modulator of platelet function.3 Moreover, as a result of reduction in calcium levels, citrated samples have resulted in low reproducibility and sensitivity to tests associated with thrombin activation of platelets.4 The non-calcium chelating anticoagulant hirudin which was introduced subsequently, is a polypeptide present in the leech (Hirudo medicinalis) having a strong and direct antithrombin activity by inhibiting the conversion of fibrinogen to fibrin. Hence, hirudin maintains the physiological milieu of the sample.5 Thrombin-receptor activating peptide-6 is used in platelet function testing in order to provide a standardized activation.6–8
Bivalirudin during percutaneous coronary intervention in acute coronary syndromes
Published in Expert Opinion on Pharmacotherapy, 2019
Marc Laine, Gilles Lemesle, Thibaut Dabry, Vassili Panagides, Michael Peyrol, Franck Paganelli, Laurent Bonello
Bivalirudin is a direct thrombin inhibitor approved for PCI in ACS patients in 2000 [5]. This synthetic anhydrous free base 20 amino-acid peptide comprised of the amino and carboxyl termini of hirudin, a natural anticoagulant derived from the saliva of the European medicinal leech Hirudo Medicinalis. This molecule weights 2180 Daltons (Table 1). The seminal publications on the pharmacological properties of bivalirudin were published in 1989 [6,7]. This drug reversibly binds to circulating and fibrin-bound thrombin. Bivalirudin targets thrombin catalytic site and anion-binding exosite I. Unlike UFH, bivalirudin does not require cofactor to develop its anticoagulant properties. Unlike UFH that increases platelet reactivity, bivalirudin targets and inhibits thrombin (a platelet agonist) and thus decreases platelet reactivity, a biological property that can be beneficial in patients undergoing PCI [8].
Proteomic characterisation of leech microglia extracellular vesicles (EVs): comparison between differential ultracentrifugation and Optiprep™ density gradient isolation
Published in Journal of Extracellular Vesicles, 2019
T Arab, A Raffo-Romero, C Van Camp, Q Lemaire, F Le Marrec-Croq, F Drago, S Aboulouard, C Slomianny, A-S Lacoste, I Guigon, H Touzet, M Salzet, I Fournier, C Lefebvre, J Vizioli, P-E Sautière
The study was performed using the annelid leech Hirudo medicinalis, in accordance with the French legislation, the European Treaty and with the Helsinki Declaration regarding the use of this species in research. Leeches were purchased from Biopharm, (Hendy, UK). Adult leeches were maintained in artificial pond water for one week before use.