Contraindications to the Use of Hirudotherapy
Limitations to the use of hirudotherapy can be divided into absolute and relative contraindications. Hirudotherapy is absolutely contraindicated in the following conditions:
- In pregnant women, as:
- Compounds contained in the secretion may cause miscarriage,
- Adverse effects, such as infection with the bacterium Aeromonas hydrophila, may occur after hirudotherapy, requiring the use of chemical drugs,
- In patients with haemophilia or other blood disorders associated with deficiencies in clotting factors,
- In individuals with advanced anaemia.
Caution should be exercised in cases of:
- Erosive gastritis and gastrointestinal bleeding,
- Concomitant use of anticoagulants, acetylsalicylic acid, and other non-steroidal anti-inflammatory drugs, as well as platelet aggregation inhibitors,
- Hypotension, when blood pressure is lower than 80/60, as fainting may occur,
- In patients with protein allergies, when severe attacks have been observed in the past; in exceptional cases, such as after replantation, hirudotherapy may be used in allergic individuals, but with the simultaneous administration of antihistamines.
It is also not recommended to perform leech application:
- In women during menstruation,
- In patients with high fever, active tuberculosis, or those infected with HIV,
- In patients with general weakness,
- In individuals with mental illness,
- In children under 10 years of age; exceptions include cases after replantation.
Common Side Effects
- Difficult-to-stop bleeding (especially in older individuals)
- Anaemia due to reduced levels of haemoglobin (Hb) and haematocrit (Htc)
- Prolongation of prothrombin time (PT), activated partial thromboplastin time (aPTT), and an increase in the international normalised ratio (INR)
Bleeding Complications
- Intense bleeding when leeches are applied to areas such as the nose, larynx, throat, oesophagus, anus, vagina, and urinary bladder
- Symptoms such as excessive sweating, shortness of breath, tachycardia, and hypotension may occur
- Bleeding from the wound typically lasts up to three days
- Internal bleeding, particularly gastrointestinal bleeding in patients with arterial thrombosis treated with acetylsalicylic acid
- In rare cases, bleeding from the urethra and haematuria may occur
Compounds Released from Leech Saliva
Prolonged bleeding from the wound and internal haemorrhages are caused by compounds released from the leech's saliva:
- Hirudin
- Histamine-like vasodilating compounds
- Hyaluronidase
- Collagenase
- Fibrinases
- Platelet inhibitors (calin and apyrase)
Infections
- Haemorrhages and ecchymoses can lead to infections
- The bacterium Aeromonas hydrophila resides in the gut of Hirudo medicinalis
- Treatment involves the use of antibiotics (third-generation cephalosporins, aminoglycosides, trimethoprim, sulfamethoxazole, and ciprofloxacin)
- Aeromonas hydrophila is resistant to first-generation cephalosporins and penicillins
- Approximately 2.4–20% of patients develop infections following hirudotherapy
Other Adverse Effects
- Microangiopathy
- Acute kidney injury
- Allergies to leech saliva
Contact Us
We understand that the information provided about the side effects and contraindications of hirudotherapy may raise questions or concerns. Please be assured that our team is here to support you and provide any additional information or guidance you may need. If you have any questions, please don't hesitate to reach out to us through any of the following channels:
Our knowledgeable staff is available to address your concerns and provide the necessary assistance to ensure your safety and well-being throughout your hirudotherapy treatment. Your health and comfort are our top priorities, and we are committed to providing you with the best possible care and support.
