bivalirudin
Brand: Angiomax
ISMP High Alert Prototype Drug
Drug Class: anticoagulant
Drug Family: anticoagulant
Subclass: direct thrombin inhibitor (bivalent)
Organ Systems: cardiovascular
Mechanism of Action
Bivalent DTI binding both catalytic site and exosite-1 of thrombin reversibly; effective against clot-bound thrombin; independent of antithrombin.
thrombin active site and exosite-1
Indications
- PCI in ACS
- HIT with thrombosis requiring anticoagulation
Contraindications
- active major bleeding
- severe renal impairment
Adverse Effects
Common
- bleeding
- back pain
- nausea
Serious
- major hemorrhage
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | extravascular |
| Metabolism | proteolysis 80% and renal 20% |
| Excretion | renal |
| Half-life | 25 minutes |
| Onset | immediate IV |
| Peak | immediate |
| Duration | 30-60 min |
| Protein Binding | 0% |
| Vd | 0.1 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| antiplatelet agents | additive bleeding risk | major |
Nursing Considerations
- Short half-life (25 min) — rapidly reversible
- aPTT target: 50-85 sec; ACT monitoring during PCI
- NOT reversed by protamine
- Drug-free interval before CABG: 1 hour
Clinical Pearls
- Effective against clot-bound thrombin unlike heparin
- HIT management: preferred in renal failure (hepatic metabolism) vs argatroban (hepatic impairment)
- Short half-life useful when brief predictable anticoagulation needed
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.