P. Flecken, A. Michalsen

Knowledge of the following contraindications is imperative to prevent serious malpractice errors with negative consequences.

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.