Side Effects of Hirudotherapy
Adverse effects following hirudotherapy are rare but can be dangerous. The most visible side effect is difficult-to-stop bleeding (especially in older individuals). Reduced levels of haemoglobin (Hb) and haematocrit (Htc) can lead to anaemia, which is the most common adverse effect of the therapy. Additionally, significant prolongation of prothrombin time (PT), activated partial thromboplastin time (aPTT), and an increase in the international normalised ratio (INR) have been noted. Coagulation disorders should be treated by administering fresh frozen plasma (FFP) twice daily, two units at a time, for two days (a total of 8 units of FFP). Applying leeches to areas such as the nose, larynx, throat, oesophagus, anus, vagina, and urinary bladder is particularly dangerous. Bleeding in these areas is more intense than when leeches are applied to other regions, often resulting in a deterioration of the patient’s overall health. Symptoms such as excessive sweating, shortness of breath, tachycardia, and hypotension may occur. Bleeding from the wound typically lasts up to three days, after which the aforementioned parameters usually return to normal. Bleeding sites should be cleaned with a solution containing povidone-iodine and dressed with a sterile dressing. Internal bleeding following hirudotherapy is a cause for concern. It has been observed that in patients with arterial thrombosis treated with acetylsalicylic acid, the application of leeches has led to gastrointestinal bleeding. In very rare cases, bleeding from the urethra and haematuria may occur. 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, and platelet inhibitors – calin, which is a collagen-induced platelet aggregation inhibitor, and apyrase, which reduces platelet aggregation by inhibiting the secretion of adenosine triphosphate.
Haemorrhages and ecchymoses can also lead to infections. It has also been detected that the bacterium Aeromonas hydrophila resides in the gut of Hirudo medicinalis. Treatment of infections caused by this bacterium involves the use of antibiotics – third-generation cephalosporins, aminoglycosides, trimethoprim, sulfamethoxazole, and ciprofloxacin. Aeromonas hydrophila is resistant to first-generation cephalosporins and penicillins. It is estimated that approximately 2.4–20% of patients develop infections following hirudotherapy. In addition to the aforementioned adverse effects, cases of microangiopathy and acute kidney injury have also been reported. Cases of allergies to leech saliva have also been noted.
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.
