Bivalirudin

Intravenous
Anticoagulant in percutaneous coronary intervention

Patients w/ ACS: Initially, 0.1 mg/kg IV bolus followed by 0.25 mg/kg/hr IV infusion. Medically managed patients may continue infusion for up to 72 hr. If will proceed to PCI: Additional IV inj of 0.5 mg/kg before the procedure then increased to 1.75 mg/kg/hr for the duration of the procedure. After PCI: Infusion may continue at 0.25 mg/kg/hr for a further 4-12 hr if necessary. If will proceed to CABG: Stop infusion 1 hr pre-op and patient should be treated w/ unfractionated heparin.

CrCl	Dosage
<30	Contraindicated.
30-59	Reduced infusion to 1.4 mg/kg/hr.
Dialysis	Contraindicated.

No dosage adjustment needed.

Dilute a 250 mg vial w/ 5 mL of sterile water for inj. Further dilute the reconstituted soln w/ 50 mL of dextrose 5% or NaCl 0.9% inj to produce a final concentration of 5 mg/mL.

Amiodarone, alteplase, diazepam, prochlorperazine, amphotericin B, vancomycin, chlorpromazine, reteplase, streptokinase. Concentration-dependent incompatibility w/ dobutamine, famotidine, haloperidol, labetalol, lorazepam and promethazine.

Active major bleeding. CrCl <30 mL/min and dialysis-dependent patients. Severe uncontrolled HTN; subacute bacterial endocarditis.

Increased risk of potentially fatal thrombosis during brachytherapy procedure. Patients at high risk of serious bleeding; recent major surgery or puncture of large vessels or organ biopsy. Renal impairment. Pregnancy, lactation, elderly.

Acute stent thrombosis, bleeding, ecchymosis, hypotension, HTN, headache, nausea, dyspepsia, insomnia, nervousness, anxiety, pelvic and abdominal pain, urinary retention, anaemia, thrombocytopaenia, inj site pain; rarely, thrombosis, tachycardia, bradycardia, vomiting, back pain, dyspnoea, fever.
Potentially Fatal: Anaphylaxis including anaphylactic shock.

IV: B

Symptoms: Bleeding. Management: Discontinue treatment w/ bivalirudin. Bivalirudin is haemodialysable.

May increase risk of bleeding when used w/ thrombolytics, oral anticoagulants or drugs that affect platelet function.

Avoid alfalfa, anise, bilberry as it may enhance the adverse/toxic effect of anticoagulants.

Description: Bivalirudin is a synthetic 20-amino acid analogue of the naturally occurring hirudin. It is a specific and reversible direct thrombin inhibitor thats works by binding to the catalytic and anionic exosite of circulating and clot-bound thrombin. It is used as an anticoagulant in percutaneous coronary intervention.
Pharmacokinetics:
Distribution: Does not bind to plasma proteins. Volume of distribution: 200 mL/kg.
Metabolism: Partly metabolised by the kidneys.
Excretion: Via urine (approx 20%) and proteolytic cleavage. Elimination half-life (normal renal function): Approx 25 min.

Unopened vial: Store between 15-30°C. Reconstituted soln: Store between 2-8°C for up to 24 hr.

Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)