Reimagining the "Eastern Aspirin": Medicinal leech derivatives in multidimensional modern therapeutics

Despite aspirin being hailed as the cornerstone of modern medicine, its"ceiling effect" in antithrombotic therapy-including aspirin resistance, bleeding risk, and the lack of protection for end organs-has emerged as a severe clinical challenge. Against this backdrop, medicinal leech therapy, with a legacy spanning thousands of years, is undergoing a scientific transformation enabled by modern pharmacology and evidence-based medicine. Hirudin and other leech derivatives have collectively been described as the natural 'Eastern Aspirin' have been acclaimed as the natural "Eastern Aspirin". This review systematically sorts out the millennial evolution of leech therapy from empirical medicine to precision medicine, provides an in-depth dissection of the multi-target pharmacological network of medicinal leeches and their derivatives, and comprehensively compares and elucidates its multi-dimensional clinical advantages over aspirin in dual-pathway anticoagulant and antithrombotic intervention, anti-inflammatory and anti-fibrotic effects, renal targeted protection, and glycolipid metabolism regulation. Combined with evidence from key high-quality randomized controlled trials including EUROMAX and HORIZONS-AMI, this paper not only confirms the superior safety of hirudin in interventional therapy for acute coronary syndrome, but also reveals its pan-vascular protective effect beyond simple anticoagulation, which is highly consistent with the pathological progression of the emerging disease entity-Cardiovascular-Kidney-Metabolic (CKM) syndrome. This paper ultimately proposes that hirudin and other leech derivatives should not merely be viewed as alternatives to aspirin, but rather as multidimensional regulators of vascular homeostasis in the CKM era. Meanwhile, it analyzes the core barriers to its clinical translation and prospects its future research directions, providing a brand-new theoretical framework and clinical guidance for the application of this ancient Oriental therapy in modern precision medicine.