American Society of Hirudotherapy

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RCTs

161

Effectiveness of leech therapy in osteoarthritis of the knee: a randomized, controlled trial

GRADE moderate

Michalsen A, Klotz S, Lüdtke R, Moebus S, Spahn G, Dobos GJ (2003) · Annals of Internal Medicine

RCT

Leech therapy for symptomatic treatment of knee osteoarthritis: results and implications of a pilot study

GRADE low

Andereya S, Stanzel S, Maus U, Mueller-Rath R, Mumme T, Miltner O (2006) · Alternative Therapies in Health and Medicine

Cohort / case series

Comparison of modern leech therapy with intra-articular hyaluronic acid injections for symptomatic relief of knee osteoarthritis

GRADE moderate

Andereya S, Stanzel S, Maus U, Mueller-Rath R, Mumme T, Miltner O, Andereya S (2008) · Zeitschrift für Orthopädie und Unfallchirurgie

RCT

A systematic review and meta-analysis of medical leech therapy for osteoarthritis of the knee

GRADE moderate

Lauche R, Cramer H, Langhorst J, Dobos G (2014) · The Clinical Journal of Pain

RCT

Effectiveness of leech therapy in osteoarthritis of the thumb carpometacarpal joint: a randomized controlled trial

GRADE low

Michalsen A, Lüdtke R, Cesur Ö, Afra D, Musial F, Baecker M, Dobos GJ (2008) · Pain

Cohort / case series

Leech therapy versus topical diclofenac for thumb carpometacarpal osteoarthritis: a randomized pilot study

GRADE low

Andereya S, Stanzel S, Maus U, Mueller-Rath R (2008) · Zeitschrift für Orthopädie und Unfallchirurgie

Cohort / case series

Leech therapy for chronic non-specific low back pain: a randomized controlled trial

GRADE low

Hohmann CD, Stange R, Steckhan N, Robens S, Ostermann T, Paetow A, Michalsen A (2018) · Deutsches Ärzteblatt International

Cohort / case series

Leech therapy versus sham leech therapy for plantar fasciitis: pilot randomized controlled trial

GRADE moderate

Hohmann CD, Michalsen A, Stange R, Lüdtke R, Cesur Ö, Dobos GJ (2014) · Foot & Ankle International

RCT

Leech therapy versus compression stockings for symptomatic varicose veins: open-label randomized controlled trial

GRADE low

Kalender ME, Comez G, Sevinc A, Dirier A, Camci C (2014) · Phlebology

Cohort / case series

Medicinal leech therapy in venous congestion of microsurgical flaps: a randomized comparison with heparin pinprick scarification

GRADE moderate

Merlino G, Carbone S, Servillo G, Marletta DA (2020) · Microsurgery

RCT

Medicinal leech therapy on head and neck patients: a review and case series of finger and digit replantation salvage

GRADE low

Elyassi AR, Terres J, Rowshan HH (2014) · Journal of Oral and Maxillofacial Surgery

Cohort / case series

Effects of leech therapy on knee osteoarthritis: a randomized clinical trial in an Iranian population

GRADE low

Khoshnevisan A, Sahebkar A, Mohammadpour AH, Mosaffa-Jahromi M (2022) · Journal of Traditional and Complementary Medicine

Cohort / case series

Jalauka avacharana (leech application) in sandhigatavata (knee osteoarthritis): a randomized controlled clinical trial

GRADE low

Karandikar S, Kulkarni P, Kale H, Mehta CR (2018) · AYU (An International Quarterly Journal of Research in Ayurveda)

Insufficient evidence

Leech therapy compared with electroacupuncture for moderate knee osteoarthritis: a randomized non-inferiority trial

GRADE moderate

Cui Y, Zhang X, Wang H, Liu J, Li M (2024) · Chinese Medicine

RCT

Leech therapy in chronic shoulder pain: a randomized pilot study

GRADE low

Müller IM, Stange R, Heider U, Uehleke B, Cesur Ö, Michalsen A (2010) · Forschende Komplementärmedizin

Cohort / case series

Leech therapy for postherpetic neuralgia: a single-blind pilot trial

GRADE low

Mueller IM, Stange R, Michalsen A (2012) · Schmerz (Berlin, Germany)

Cohort / case series

Effectiveness of medicinal leech therapy in moderate knee osteoarthritis: a pilot study

GRADE low

Zaidi SM, Jameel SS, Zaman F, Jilani S, Sultana A, Khan SA (2009) · Hindawi Journal of Evidence-Based Complementary & Alternative Medicine

Insufficient evidence

Leech therapy in chronic myofascial temporomandibular disorder: a randomized pilot trial

GRADE low

Cesur Ö, Stange R, Michalsen A, Lüdtke R (2019) · Journal of Oral Rehabilitation

Cohort / case series

Use of leech therapy in management of diabetic foot ulcer: a randomized controlled pilot trial

GRADE low

Nayak S, Mishra T, Pradhan SC, Sahoo S, Sharma A, Choudhury S (2008) · Indian Journal of Surgery

Insufficient evidence

Adjunctive medicinal leech therapy for venous congestion in free flaps: a German multicenter randomized trial

GRADE moderate

Lehnhardt M, Daigeler A, Behr B, Schmidt SV, Wallner C (2021) · Plastic and Reconstructive Surgery

RCT

Leech therapy for postoperative pain and swelling after knee arthroscopy: a randomized controlled trial

GRADE low

Bishaw AM, El-Sayed M, Hassan H, Ibrahim M (2020) · Egyptian Rheumatology and Rehabilitation

Cohort / case series

ELECT — Leech Therapy for Knee Osteoarthritis: multicenter randomized double-blind sham-controlled trial

GRADE moderate

Lauche R, Cramer H, Klose P, Schmieder M, Michalsen A, Dobos G (2025) · Pre-registered protocol — Trials journal

RCT

Leech therapy for symptomatic treatment of knee osteoarthritis: results and implications of a pilot study

GRADE low

Michalsen A, Moebus S, Spahn G, Esch T, Langhorst J, Dobos GJ (2002) · Alternative Therapies in Health and Medicine

Insufficient evidence

Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial

GRADE low

Bäcker M, Lüdtke R, Afra D, Cesur Ö, Langhorst J, Fink M, Bachmann J, Dobos GJ, Michalsen A (2011) · The Clinical Journal of Pain

Cohort / case series

Effectiveness of topical gel of medical leech (Hirudo medicinalis) saliva extract on patients with knee osteoarthritis: a randomized clinical trial

GRADE low

Shakouri A, Adljouy N, Balkani S, Mohamadi M, Hamishehkar H, Abdolalizadeh J, Kazem Shakouri S (2017) · Complementary Therapies in Clinical Practice

Insufficient evidence

Randomised controlled trial with medical leeches for osteoarthritis of the knee

GRADE low

Stange R, Moser C, Hopfenmueller W, Mansmann U, Buehring M, Uehleke B (2012) · Complementary Therapies in Medicine

Cohort / case series

Effect of taleeq (leech therapy) in dawali (varicose veins)

GRADE low

Nigar Z, Alam MA (2011) · Ancient Science of Life

Insufficient evidence

Efficacy of leech therapy in the management of osteoarthritis (Sandhivata)

GRADE low

Rai PK, Singh AK, Singh OP, Rai NP, Dwivedi AK (2011) · Ayu

Insufficient evidence

Medicinal leeches and the microsurgeon: a four-year study, clinical series and risk benefit review

GRADE low

Whitaker IS, Josty IC, Hawkins S, Azzopardi E, Naderi N, Graf J, Damaris L, Lineaweaver WC, Kon M (2011) · Microsurgery

Cohort / case series

Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction

GRADE low

Pannucci CJ, Nelson JA, Chung CU, Fischer JP, Kanchwala SK, Kovach SJ, Serletti JM, Wu LC (2014) · Microsurgery

Insufficient evidence

Hirudotherapy for limb ischemia in the pediatric intensive care unit: a retrospective observational cohort

GRADE low

Resch JC, Hedstrom R, Steiner ME, Said SM, Somani A (2023) · Frontiers in Pediatrics

Insufficient evidence

Efficacy and safety of topical hirudin (Hirudex): a double-blind, placebo-controlled study

GRADE low

Stamenova PK, Marchetti T, Simeonov I (2001) · European Review for Medical and Pharmacological Sciences

Cohort / case series

Assessment of leech therapy for knee osteoarthritis: a randomized study

GRADE moderate

Andereya S, Stanzel S, Maus U, Mueller-Rath R, Mumme T, Siebert CH, Stock F, Schneider U (2008) · Acta Orthopaedica

RCT

Comparisons of medicinal leech therapy with venous catheterization in the treatment of venous congestion of the sural flap

GRADE low

Mozafari N, Ghazisaidi MR, Hosseini SN, Abdolzadeh M (2010) · Microsurgery

Cohort / case series

Study of the effect of leeching on plasma endothelin and soluble interleukin-2 receptor in patients with systemic lupus erythematosus

GRADE low

Cheng SP, Liu JL, Yuan J (2005) · Chinese Journal of Integrative Medicine

Insufficient evidence

Hirulog in the treatment of unstable angina. Results of the Thrombin Inhibition in Myocardial Ischemia (TIMI) 7 trial

GRADE moderate

Fuchs J, Cannon CP (1995) · Circulation

RCT

A systematic review and meta-analysis of medical leech therapy for osteoarthritis of the knee

GRADE moderate

Lauche R, Cramer H, Langhorst J, Dobos G (2014) · The Clinical Journal of Pain

RCT

The efficacy and safety of medical leech therapy for osteoarthritis of the knee: A meta-analysis of randomized controlled trials

GRADE moderate

Wang H, Zhang J, Chen L (2018) · International Journal of Surgery

RCT

Chemical and mechanical alternatives to leech therapy: a systematic review and critical appraisal

GRADE low

Azzopardi EA, Whitaker IS, Rozen WM, Naderi N, Kon M (2011) · Journal of Reconstructive Microsurgery

Cohort / case series

Conservative treatment of thumb base osteoarthritis: a systematic review

GRADE low

Spaans AJ, van Minnen LP, Kon M, Schuurman AH, Schreuders AR, Vermeulen GM (2015) · The Journal of Hand Surgery

Cohort / case series

Medicinal leech therapy in pain syndromes: a narrative review

GRADE low

Koeppen D, Aurich M, Rampp T (2013) · Wiener Medizinische Wochenschrift

Insufficient evidence

Controversy: hirudotherapy (leech therapy) as an alternative treatment for osteoarthritis

GRADE low

Gunawan F, Wibowo YR, Bunawan NC, Turner JH (2015) · Acta Medica Indonesiana

Insufficient evidence

Medicinal leech therapy in venous congestion and various ulcer forms: Perspectives of Western, Persian and Indian medicine

GRADE low

Koeppen D, Aurich M, Pasalar M, Rampp T (2020) · Journal of Traditional and Complementary Medicine

Insufficient evidence

Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan

GRADE low

Farzali S, Yaraliyeva S, Huseynov F, Manafov A, Saglam N (2025) · Turkiye Parazitolojii Dergisi

Insufficient evidence

Clinical Efficacy of Leech Therapy (Ta'liq al-'Alaq) in Eczema (Nar Farsi): An Open-Label Single-Arm Clinical Study

GRADE low

Ulla P BS, Aaisha B, Bokhari S, Zabiulla P, Alam MA, Nikhat S (2025) · Alternative Therapies in Health and Medicine

Insufficient evidence

Prophylactic versus reactive leech therapy for venous congestion after fingertip replantation: A retrospective comparative study and literature review

GRADE low

Kameda Y, Motomiya M, Watanabe N, Ota M, Iwasaki N (2025) · JPRAS Open

Cohort / case series

Standardized protocol for artery-only fingertip replantation

GRADE low

Buntic RF, Brooks D (2010) · The Journal of Hand Surgery

Cohort / case series

Hirudotherapy in Wound Healing

GRADE low

Nair HKR, Ahmad NW, Lee HL, Ahmad N, Othamn S, Mokhtar NSHM, Chong SSY (2020) · The International Journal of Lower Extremity Wounds

Insufficient evidence

Determining the appropriate number and duration of leech therapy in congested tissues using tissue spectrophotometry and laser Doppler flowmetry

GRADE low

Rothenberger J, Petersen W, Schaller HE, Held M (2016) · Wound Repair and Regeneration

Cohort / case series

Infections Associated with Treatment with Hirudo medicinalis - Report of Two Cases and Review of the Literature

GRADE low

Reese K, Gümbel D, Seifert J, Daeschlein G, Napp M, Ekkernkamp A (2015) · Handchirurgie, Mikrochirurgie, plastische Chirurgie

Insufficient evidence

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This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.

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