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Leech therapy involves an initial bite, which is usually painless (it's thought that leech saliva contains a mild anesthetic); an attachment period lasting 20 to 45 minutes, during which the leech sucks between 5 and 15 mL of blood; and a postattachment period, during which the site continues to bleed.4, 7 The final stage provides the primary therapeutic benefit; it's caused by components in the leech's saliva, including hirudin, a protein anticoagulant that inhibits thrombin in the clotting process, as well as histamine-like substances that induce vasodilation.
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