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The leech's anticoagulant, made by recombinant expression — a 65-residue polypeptide that switches thrombin off directly.
Also known as: CGP 39393 · Iprivask · Revasc · recombinant hirudin · 63-desulfohirudin
Part of the Foundational & therapeutic peptides cluster
Overview
Desirudin (Iprivask, Revasc) is a recombinant 65-amino-acid form of hirudin, the anticoagulant polypeptide from the saliva of the medicinal leech, differing from the natural molecule by lacking a sulfate on tyrosine 63. It binds thrombin directly and reversibly, blocking conversion of fibrinogen to fibrin. It was the first direct thrombin inhibitor approved in Europe for deep vein thrombosis prophylaxis and was later approved in the US, where it is no longer marketed.
Source & context
Biological / chemical source: Recombinant form of hirudin, the salivary anticoagulant of the medicinal leech
Primary research or clinical context: Approved (FDA; first DTI approved in Europe for DVT prophylaxis) to prevent deep vein thrombosis after hip replacement surgery; no longer marketed in the United States
What desirudin is
Desirudin is a recombinant version of hirudin, the anticoagulant that the medicinal leech secretes to keep its host's blood flowing. Produced by recombinant expression rather than extraction, it is a 65-amino-acid polypeptide identical to the natural hirudin variant HV1 except for one detail: natural hirudin carries a sulfated tyrosine at position 63, and the recombinant molecule does not, which is why it is also called 63-desulfohirudin. It was the first direct thrombin inhibitor approved in Europe for deep vein thrombosis prophylaxis, marketed as Revasc, and later the newest injectable DTI available in the US as Iprivask (Graetz et al., Expert Review of Cardiovascular Therapy 2011).
Sequence and structure
The IUPHAR sequence — VVYTDCTESGQNLCLCEGSNVCGQGNKCILGSDGEKNQCVTGEGTPKPQSHNDGDFEEIPEEYLQ — is 65 residues, above the 60-residue limit for chip display on this site. Three disulfide bridges (6–14, 16–28 and 22–39) fold the N-terminal half into a compact core that occupies thrombin's active site, while the acidic C-terminal tail (…DFEEIPEEYLQ) binds thrombin's fibrinogen-recognition exosite. That two-point attachment is what makes hirudins the most potent natural thrombin inhibitors known. Molecular formula and mass appear in the structure block from PubChem.
Mechanism
Desirudin is a competitive and reversible inhibitor of thrombin, the serine protease at the end of the coagulation cascade. Thrombin inhibition interrupts the conversion of fibrinogen to fibrin and so prevents clot formation (IUPHAR mechanism record). Unlike heparin, which works indirectly through antithrombin and cannot reach thrombin already bound in a clot, desirudin inhibits both free and fibrin-bound thrombin and needs no cofactor (Graetz et al. 2011). Direct thrombin inhibitors as a class were developed to overcome heparin's limitations, including heparin-induced thrombocytopenia (Lee & Ansell, British Journal of Clinical Pharmacology 2011).
Clinical use and immunogenicity
Desirudin is used to prevent deep vein thrombosis and pulmonary embolism in patients undergoing hip replacement surgery, given subcutaneously twice daily, and it is one of the few non-heparin subcutaneous anticoagulants available for that setting (IUPHAR clinical record; LiverTox 2018). Because hirudins are foreign proteins, antibody formation is a recognised concern: the largest immunogenicity study to date evaluated IgG responses to desirudin in 245 surgical patients, and also showed that thrombin can interfere with the assays used to detect hirudin-specific antibodies (Hamilton et al., Journal of Immunological Methods 2012). Desirudin has not been linked to liver injury (LiverTox).
Status as of September 2026
Desirudin remains an approved direct thrombin inhibitor, but according to the Drugs and Lactation Database it is no longer marketed in the United States. The ClinicalTrials.gov search for the name returns mostly unrelated studies matching the “REVASC” acronym, reflecting how little active clinical development there is. Recombinant hirudins have largely been displaced by newer parenteral DTIs (bivalirudin, argatroban) and oral anticoagulants.
Relation to other peptides on this site
Bivalirudin, on this site, is a 20-residue synthetic peptide designed from hirudin's two thrombin-binding regions joined by a glycine linker — a deliberately shortened, reversible version of the same idea. Aprotinin is the mirror image: a natural polypeptide inhibitor of the enzymes that dissolve clots. Together they bracket the coagulation cascade from both ends.
Structure & chemistry
Molecular identity & reference confidence
Source-supported reference
Reference values are taken from the cited molecular record or curated profile. A database match is not independent laboratory verification; modifications, counter-ions, and formulations can change the measured mass.
- Molecular form
- 65-residue recombinant hirudin variant HV1 with three disulfide bridges (6–14, 16–28, 22–39); lacks the sulfated Tyr63 of natural hirudin
- Species
- Not established by this molecular identity audit
- Termini (N / C)
- Not specified / Not specified
Average reference mass
Reference policy updated: 2026-10-05
- IUPHAR/BPS source snapshot · 2026-10-01
- PubChem molecular record · 2026-10-01
- Molecular formula
- C287H440N80O110S6
- Average reference mass
- ≈ 6,963
- Receptors
- No receptor — binds the active site and exosite of thrombin directly (competitive, reversible inhibition)
- Backbone
- 65-residue recombinant hirudin variant HV1 with three disulfide bridges (6–14, 16–28, 22–39); lacks the sulfated Tyr63 of natural hirudin
- Status
- Approved (US FDA; Europe as Revasc) for DVT prophylaxis in hip replacement. No longer marketed in the United States per the LactMed record
Disulfide bridges: 6–14; 16–28; 22–39 (IUPHAR record). Natural hirudin carries a sulfated tyrosine at position 63; the recombinant desirudin does not (hence '63-desulfohirudin').
- PubChem CID: 16129703
- IUPHAR ligand: 6458
- ChEMBL: CHEMBL1201662
- CAS RN: 120993-53-5
- UNII: U0JZ726775
Chemistry values: curated profile, PubChem, IUPHAR/BPS Guide to Pharmacology · fetched 2026-10-01.
Clinical development snapshot
ClinicalTrials.gov lists 11 registered studies with “Desirudin” as an intervention (snapshot 2026-09-07). A registry footprint is not evidence of efficacy or approval.
| NCT | Title | Phase | Status | Updated |
|---|---|---|---|---|
| NCT03289728 | Evaluation of a Strategy Guided by Imaging Versus Systematic Coronary Angiography in Elderly Patients With Isc | Not applicable | terminated | 2026-06-03 |
| NCT07223437 | REVASC-PAD: REstricted VASCular Exercise for Peripheral Arterial Disease - A Feasibility Study at University o | Not applicable | recruiting | 2026-04-29 |
| NCT07426107 | Development and Prospective Validation of an AI Model for Prognosis in ITP Patients Undergoing Coronary Revasc | — | not yet recruiting | 2026-02-23 |
| NCT02797158 | Post TAVI Coronary REVASCularisation Guided by Myocardial Perfusion Imaging: a Prospective Open Label Pilot St | Not applicable | completed | 2025-09-30 |
| NCT01976065 | Regeneration of Pulp-Dentin Development in Teeth With Necrotic Pulps and Immature Roots | Phase 1 | completed | 2023-09-07 |
| NCT02060630 | Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia | Not applicable | completed | 2023-04-11 |
Desirudin — reconstitution calculator
Enter how much peptide is in the vial and how much diluent (e.g. bacteriostatic water) is added. The tool returns the resulting solution concentration — and, for any amount you type, the volume it corresponds to. This is educational arithmetic, not a dosing recommendation.
Reference form: 65-residue recombinant hirudin variant HV1 with three disulfide bridges (6–14, 16–28, 22–39); lacks the sulfated Tyr63 of natural hirudinAverage reference mass: 6,963 Da
Enter an amount to see the volume it corresponds to.
Educational concentration mathematics only. This tool does not recommend a dose, amount, or protocol, and nothing here is medical advice. Many peptides are not authorized by Health Canada for human use — see our reconstitution and bacteriostatic-water guides for context.
Change log
Dated observations from the data pipeline (registry flags, trial footprints, identifiers) and editorial reviews of this profile.
- IdentifiersCross-linked to IUPHAR ligand 6458 and PubChem CID 16129703.
- TrialsClinicalTrials.gov snapshot added: 11 registered studies, highest phase 4.
- EditorialProfile content reviewed and updated by the editorial team.
FAQ about Desirudin
What is Desirudin?+
Desirudin (Iprivask, Revasc) is a recombinant 65-amino-acid form of hirudin, the anticoagulant polypeptide from the saliva of the medicinal leech, differing from the natural molecule by lacking a sulfate on tyrosine 63. It binds thrombin directly and reversibly, blocking conversion of fibrinogen to fibrin. It was the first direct thrombin inhibitor approved in Europe for deep vein thrombosis prophylaxis and was later approved in the US, where it is no longer marketed.
What Canadian product status is recorded for Desirudin?+
Canadian product status for Desirudin has not been verified in this profile. No verified record here does not mean no authorization exists. Status depends on the product, formulation and use; consult Health Canada's product records.
What is the typical length of Desirudin?+
Desirudin is commonly described as approximately 65 amino acids (Direct thrombin inhibitor (recombinant hirudin)).
What is desirudin?+
A recombinant 65-amino-acid form of leech hirudin that directly and reversibly inhibits thrombin. Sold as Iprivask (US) and Revasc (Europe) for DVT prophylaxis after hip replacement.
How does desirudin differ from natural hirudin?+
Only by the absence of a sulfate group on tyrosine 63, a consequence of recombinant production — hence the name 63-desulfohirudin.
How does desirudin differ from heparin?+
Heparin acts indirectly via antithrombin and cannot inhibit clot-bound thrombin; desirudin binds thrombin directly, free or fibrin-bound, with no cofactor.
Is desirudin still available?+
It is approved, but the LactMed record states it is no longer marketed in the United States.
Is desirudin the same as lepirudin?+
No. Both are recombinant hirudins with the same mechanism, but they are distinct products; lepirudin has its own profile.
Related peptides
References & further reading
- 1.Graetz TJ et al. (2011). Desirudin: a review of the pharmacology and clinical application for the prevention of deep vein thrombosis. Expert Review of Cardiovascular Therapy
- 2.Lee CJ & Ansell JE (2011). Direct thrombin inhibitors. British Journal of Clinical Pharmacology
- 3.Hamilton RG et al. (2012). Interference of thrombin in immunological assays for hirudin specific antibodies. Journal of Immunological Methods
- 4.LiverTox (2018). Desirudin. NIDDK
- 5.Drugs and Lactation Database (2023). Desirudin. NICHD
- 6.PubChem — Desirudin (CID 16129703)