Bivalirudin

Trade names

ANGIOMAX

ANGIOX

Actions

• Direct thrombin inhibitor

Route of Administration

Intravenous

Bioavailability

100%

Plasma protein binding

None except to thrombin.

Time to peak plasma concentration

0.25–2 h

Half-life

24 min

Duration of action

1 h

Metabolism

Enzymes involved

• Proteolytic cleavage.
• No CYP involved.

Elimination

Renal 20%

Recommended dose

Patients that undergo PCI, with or without STEMI:

0.75 mg/kg bolus followed by an infusion of 1.75 mg/kg/hour for the duration of the PCI procedure. Five min after the bolus dose has been administered, an activated clotting time (ACT) should be performed and an additional bolus of 0.3 mg/kg should be given if needed.

Patients with unstable angina or NSTEMI:

0.1 mg/kg followed by an infusion of 0.25 mg/kg/hour.

Renal impairment

In patients with creatinine clearance 30–59 ml/min that undergo PCI the infusion dose should be reduced to 1.4 mg/kg/hour. The bolus dose should be unchanged.

Bivalirudin is not recommended in patients with creatinine clearance <30 ml/min.

Discontinuation before invasive procedures

Stop 1 hour prior to an invasive procedure.