Drug reference

Bivalirudin

Anticoagulant

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Manufacturer advises avoid unless potential beneﬁt outweighs risk—no information available.

FDA category + note

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Mechanism

Bivalirudin, a hirudin analogue, is a thrombin inhibitor. It directly inhibits even clot-bound thrombin, is not affected by circulating inhibitors, and functions independently of antithrombin III.

Indications

Unstable angina or non-ST-segment elevation myocardial infarction in patients planned for urgent or early intervention (in addition to aspirin and clopidogrel)Unstable angina or non-ST-segment elevation myocardial infarction (in addition to aspirin and clopidogrel) in patients proceeding to percutaneous coronary intervention or coronary artery bypass surgery without cardiopulmonary bypassAnticoagulation in patients undergoing percutaneous coronary intervention including patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (in addition to aspirin and clopidogrel)Alternative to heparin in patients undergoing coronary angioplastyAlternative to heparin in patients undergoing cardiopulmonary bypass surgeryAnticoagulation for patients with heparin-induced thrombocytopenia or a history of this disorder during coronary angioplastypercutaneous coronary interventionheparin-induced thrombocytopeniaSimilar to lepirudinAnticoagulant therapy added to antiplatelet agents for NSTE-ACS, used just prior to and/or during PCIAlternative to UFH in patients undergoing primary PCIVTE in the setting of suspected or proven heparin-induced thrombocytopenia

Dosing

Adult: Unstable angina or non-ST-segment elevation myocardial infarction in patients planned for urgent or early intervention: Initially 100 micrograms/kg by intravenous injection, then 250 micrograms/kg/hour by intravenous infusion (for up to 72 hours in medically managed patients).…
Renal adjustment: Avoid if eGFR less than 30 mL/minute/1.73 m2. When used for percutaneous coronary intervention, reduce rate of infusion to 1.4 mg/kg/hour if eGFR 30–60 mL/minute/1.73 m2 and monitor blood clotting parameters.

Pharmacokinetics

Half-life

25 minutes

Contraindications

Bleeding (active)
Bleeding disorders
Hypertension (severe)
Subacute bacterial endocarditis

Side effects

Common

Procedural complicationsSkin reactions

Serious

Anaemia
Headache
Hypersensitivity
Hypotension
Shock
Thrombocytopenia
Arrhythmias
Cardiac tamponade
Chest pain
Compartment syndrome
Dyspnoea
Embolism and thrombosis
Intracranial haemorrhage
Pain
Vascular disorders
Vomiting
Bleeding (though associated with a lower rate compared to UFH plus a glycoprotein IIb/IIIa inhibitor, largely driven by reductions in vascular access site hematomas ≥5 cm or blood transfusions)