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Bivalirudin
From WikEM
Contents
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
