Bivalirudin

Administration

  • Type: Anticoagulant (Direct thrombin inhibitor)
  • Dosage Forms: powder for injection
  • Dosage Strengths: 250mg
  • Routes of Administration: IV
  • Common Trade Names: Angiomax, Angiox

Adult Dosing

  • Acute MI, adjunct to thrombolysis: 0.25 mg/kg IV bolus + 0.5 mg/kg/hr x 12h, then 0.25 mg/kg/hr x 36h
  • PCI Thrombosis prophylaxis: 0.75 mg/kg IV bolus + 1.75 mg/kg/hr IV infusion during procedure + 0.2mg/kg/hr x 4-20h after procedure
  • Unstable angina/NSTEMI: 0.1 mg/kg IV bolus + 0.25 mg/kg/hour IV infusion

Pediatric Dosing

Safety/efficacy not established

Special Populations

  • Pregnancy Rating: B
  • Lactation risk: Infant risk cannot be ruled out
  • Renal dosing: no adjustment in bolus dosing
    • CrCl 30-59 mL/min: no adjustment in infusion or bolus dose
    • CrCl <30: consider reducing infusion to 1 mg/kg/hr
    • Hemodialysis: Reduce infusion rate to 0.25 mg/kg/hr
  • Hepatic dosing:

Contraindications

  • Allergy to class/drug
  • Active major bleeding

Adverse Reactions

Serious

  • Major bleeding: retroperitoneal, intracranial hemorrhage
  • Coronary artery stent thrombosis, ventricular fibrillation
  • Thrombosis
  • Cerebral ischemia
  • Peripheral facial palsy
  • Oliguria, renal failure
  • Sepsis

Common

  • Hypotension
  • Minor bleeding
  • Nausea
  • Headache, backache, pain

Pharmacology

  • Half-life: 25 min
  • Metabolism: Blood proteases
  • Excretion: Renal

Mechanism of Action

  • Binds to and inhibits thrombin

Comments

See Also

References

Authors:

Claire, Matin Shah