Bivalirudin

Bivalirudin Brand Names- Angiomax | Bivalirudin

What is Bivalirudin

Bivalirudin is a direct thrombin inhibitor indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI), including patients with heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis syndrome (HITTS).

It is a parenteral bivalent analog of hirudin. Hirudin is a natural anticoagulant secreted in the saliva of the medicinal leech, Hirudo medicinalis. In comparison to heparin which binds only circulating thrombin, direct thrombin inhibitors block circulating thrombin and clot-bound thrombin.

Bivalirudin with or without prior treatment with heparin is recommended for patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI.

Guidelines recommend bivalirudin (or argatroban) over other nonheparin anticoagulants for patients with acute or subacute HIT who require PCI. The use of bivalirudin is also recommended over other nonheparin anticoagulants and heparin plus antiplatelet agents for patients with acute or subacute HIT who require urgent cardiac surgery.

Additionally, bivalirudin is recommended as initial anticoagulation before PCI or angiography in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).

In patients undergoing PCI who are at high risk of bleeding, it is reasonable to use bivalirudin monotherapy in preference to the combination of heparin and a GP IIb/IIa receptor antagonist.

Acute stent thrombosis has been reported at a higher incidence in patients treated with bivalirudin compared to heparin for STEMI undergoing PCI.

Patients must be carefully monitored for at least 24 hours after primary PCI for signs and symptoms consistent with myocardial ischemia in a facility capable of managing ischemic complications.

Indications

  1. acute myocardial infarction, NSTEMI
  2. cardiac surgery
  3. cardiopulmonary bypass
  4. deep venous thrombosis (DVT) prophylaxis
  5. heparin-induced thrombocytopenia
  6. percutaneous coronary intervention (PCI)
  7. thrombosis prophylaxis
  8. unstable angina

For use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI) including patients with heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia and thrombosis syndrome (HITTS)

Side Effects

  1. anaphylactoid reactions
  2. antibody formation
  3. bleeding
  4. cardiac tamponade
  5. intracranial bleeding
  6. retroperitoneal bleeding
  7. thrombocytopenia
  8. thrombosis

Monitoring Parameters

  • clotting time
  • hemoglobin/hematocrit

Contraindications

  • bleeding
  • breast-feeding
  • geriatric
  • labor
  • myocardial infarction
  • obstetric delivery
  • pregnancy
  • renal failure
  • renal impairment
  • thromboembolism

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Ado-Trastuzumab emtansine
  • Altretamine
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amlodipine; Celecoxib
  • Anagrelide
  • Antithrombin III
  • Antithymocyte Globulin
  • Apixaban
  • Argatroban
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Azelastine; Fluticasone
  • Beclomethasone
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Betamethasone
  • Betrixaban
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Budesonide
  • Budesonide; Formoterol
  • Caplacizumab
  • Carbenicillin
  • Celecoxib
  • Chlorambucil
  • Choline Salicylate; Magnesium Salicylate
  • Ciclesonide
  • Cilostazol
  • Citalopram
  • Clofarabine
  • Clopidogrel
  • Collagenase
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cytarabine, ARA-C
  • Dabigatran
  • Dalteparin
  • Dasatinib
  • Decitabine
  • Deferasirox
  • Defibrotide
  • Deflazacort
  • Denileukin Diftitox
  • Desirudin
  • Dexamethasone
  • Dextran
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dipyridamole
  • Drotrecogin Alfa
  • Edoxaban
  • Eltrombopag
  • Enoxaparin
  • Epoprostenol
  • Eptifibatide
  • Escitalopram
  • Esomeprazole; Naproxen
  • Esterified Estrogens; Methyltestosterone
  • Estramustine
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Floxuridine
  • Fludrocortisone
  • Flunisolide
  • Fluorouracil, 5-FU
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Folate analogs
  • Fondaparinux
  • Formoterol; Mometasone
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ginkgo, Ginkgo biloba
  • Green Tea
  • Hemin
  • Heparin
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Hydroxyurea
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Icosapent ethyl
  • Iloprost
  • Indomethacin
  • Inotersen
  • Interferon Alfa-2a
  • Interferon Alfa-2b
  • Interferon Alfa-2b; Ribavirin
  • Interferon Alfa-n3
  • Interferon Alfacon-1
  • Intravenous Lipid Emulsions
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lepirudin
  • Lithium
  • Lomustine, CCNU
  • Magnesium Salicylate
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Methoxsalen
  • Methylprednisolone
  • Methylsulfonylmethane, MSM
  • Methyltestosterone
  • Mifepristone
  • Miltefosine
  • Mometasone
  • Mycophenolate
  • Nabumetone
  • Nandrolone Decanoate
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Natural Antineoplastics
  • Nelarabine
  • Nintedanib
  • Nonsteroidal antiinflammatory drugs
  • Obinutuzumab
  • Omacetaxine
  • Oxandrolone
  • Oxaprozin
  • Paroxetine
  • Pentosan
  • Phentermine; Topiramate
  • Piperacillin
  • Piperacillin; Tazobactam
  • Piroxicam
  • Platelet Inhibitors
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Prasugrel
  • Prednisolone
  • Prednisone
  • Rivaroxaban
  • Rofecoxib
  • Salicylates
  • Salsalate
  • Selective serotonin reuptake inhibitors
  • Serotonin norepinephrine reuptake inhibitors
  • Sertraline
  • Sodium Iodide
  • Sulfinpyrazone
  • Sulindac
  • Telavancin
  • Thrombolytic Agents
  • Ticagrelor
  • Ticarcillin
  • Ticarcillin; Clavulanic Acid
  • Ticlopidine
  • Tinzaparin
  • Tipranavir
  • Tirofiban
  • Tolmetin
  • Tolvaptan
  • Topiramate
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Triamcinolone
  • Valdecoxib
  • Verteporfin
  • Vilazodone
  • Vorapaxar
  • Vorinostat
  • Vortioxetine
  • Warfarin
15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856