Desirudin

Cardiovascular / Anticoagulant

Also known as: Iprivask, Desirudin Injection, Recombinant Hirudin

Direct Thrombin Inhibitors (Leech-Derived)Research phase: FDA-approvedRegulatory: FDA-approved (2003) for DVT prophylaxis following hip replacement surgery (Iprivask). Availability limited; discontinued in some markets.

Mechanism

Desirudin is a recombinant version of hirudin — the anticoagulant protein from medicinal leeches. It directly inhibits thrombin (the central enzyme in blood clotting) without needing antithrombin as a cofactor, unlike heparin. It is one of the most potent and specific thrombin inhibitors known. It was FDA-approved for preventing blood clots after hip replacement surgery.

Technical detail

Desirudin is a 65-amino-acid recombinant desulfated variant of hirudin from Hirudo medicinalis, produced in Saccharomyces cerevisiae. It is a bivalent direct thrombin inhibitor (DTI): the N-terminal domain binds the thrombin active site (competitive inhibition) while the C-terminal tail binds exosite I (fibrinogen recognition site), forming a virtually irreversible 1:1 stoichiometric complex (Ki ~10^-15 M). It inhibits both free and clot-bound thrombin (unlike heparin which only inhibits free thrombin). Does not require antithrombin III as a cofactor. Subcutaneous administration with renal elimination. Not reversed by protamine.

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