Case report: Heparin coagulant super-sensitivity during leech therapy.

Area of Science:

• Integrative Medicine
• Hematology
• Surgical Complications

Background:

• Leech therapy is utilized for conditions such as flap salvage and osteoarthritis.
• Bleeding is a known side effect, but severe coagulopathy is rare and often underreported, especially with concurrent anticoagulant use.

Purpose of the Study:

• To report a case of severe coagulopathy resulting from combined leech therapy and systemic heparin use.
• To highlight the potential synergistic anticoagulant effects and the need for monitoring.

Main Methods:

• A 76-year-old female received leech therapy combined with systemic heparin for flap salvage post-glossectomy.
• Coagulation markers, including activated partial thromboplastin time (aPTT) and thrombin time, were monitored.
• Treatment adjustments were made based on bleeding and laboratory results.

Main Results:

• The patient developed marked coagulopathy with prolonged aPTT and elevated thrombin time.
• Bleeding persisted despite heparin discontinuation, resolving only after halting leech therapy.
• The patient required 8 units of packed red blood cells (pRBCs).

Conclusions:

• Combined leech and systemic anticoagulation therapy poses an underrecognized risk of severe coagulopathy.
• Heparin and hirudin (from leeches) may synergistically inhibit thrombin activity.
• Proposed daily monitoring of aPTT, PT/INR, and one-time thrombin time/anti-Xa levels is recommended; standardized protocols are needed.