Bivalirudin

Administration

• Type: Anticoagulant (Direct thrombin inhibitor)
• Dosage Forms:
• Routes of Administration: IV
• Common Trade Names: Angiomax

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: 25min
• Metabolism: Renal
• Excretion:

Mechanism of Action

• Binds to and inhibits thrombin

See Also

• Anticoagulant reversal for life-threatening bleeds

References

Authors

Claire