Contradictions for Leech Therapy: Hemophilia, Anemia, Anticoagulant Medications

Any type of congenital or acquired hemophilia or concurrent medication with the anticoagulants Marcumar, warfarin, heparin, or heparinoids is an absolute contraindication to leech therapy. Patients should be specifically asked to subjectively assess whether they have any abnormal bleeding tendencies. In the observation study performed by researchers at Essen-Mitte Hospital, extremely prolonged bleeding from the leech bite was observed in isolated cases. Retrospective case analysis revealed that these patients had undiagnosed tendencies to increased bleeding. Aspirin and clopidogrel are not contraindications per se, but the number of leeches applied should be reduced in the first treatment session, and the patient should be asked about bleeding tendencies. If clopidogrel and aspirin are being used in combination, then clopidogrel should be discontinued five days before leech therapy if medically feasible. Bleeding time after leeching may be significantly prolonged in patients taking high-dose fish oil or gingko biloba products. These patients should also temporarily discontinue these medications before leech therapy.

Any type of treatment involving blood removal is generally contraindicated in patients with anemia or bone-marrow suppression.

Leech therapy should never be performed in patients with severe, unstable organic disease or marked immunosuppression (chemotherapy). Severe, chronic yet stable organ diseases such as cirrhosis of the liver (warning: coagulation disorders! ), connective tissue diseases, dialysis, immune diseases, and diseases of the blood-forming organs are relative contraindications. Leech therapy can be performed with concomitant antibiotic therapy if the patient has normal blood coagulation in the absence of anemia or immu-nosuppression if there is a justifiable indication (pain management). Leech therapy is contraindicated in individuals with HIV infection. No treatments involving the removal of blood should be performed in patients with cachexia of any cause. Leech therapy can be administered to patients on corticosteroids if the drug is given in low to medium doses and if the patient does not have a history of wound-healing disorders or cortisone-related skin changes ("cortisone skin").

Other Contradictions for Leech Therapy

Petra Flecken, Germany