bivalirudin

bivalirudin /bi·val·i·ru·din/ (bi-val´ĭroo-din) an anticoagulant used with aspirin in patients with unstable angina pectoris who are undergoing percutaneous transluminal coronary angioplasty.

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bivalirudin

[bi-val′roo-din]

an inhibitor of the clot-promoting activity of thrombin, used in conjunction with aspirin as an anticoagulant in patients with unstable angina pectoris who are undergoing percutaneous transluminal coronary angioplasty; administered intravenously.

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bivalirudin

Angiomax, Bipranix (UK), Cardicor (UK), Emcor (UK), Soloc (UK), Vivacor (UK)

Pharmacologic class: Thrombin inhibitor

Therapeutic class: Anticoagulant

Pregnancy risk category B

Action

Selectively inhibits thrombin by binding to its receptor sites, causing inactivation of coagulation factors V, VIII, and XII and thus preventing conversion of fibrinogen to fibrin

Availability

Powder for injection: 250 mg/vial

⊘Indications and dosages

➣ Patients with unstable angina who are undergoing percutaneous transluminal angioplasty (PTCA)

Adults: 1 mg/kg I.V. bolus just before PCTA; then start 4-hour I.V. infusion at 2.5 mg/kg/hour. After 4-hour infusion, may give additional I.V. infusion at 0.2 mg/kg/hour for up to 20 hours, along with aspirin as ordered.

Dosage adjustment

• Renal impairment
• Dialysis patients

Off-label uses

• PCTA (regardless of history of unstable angina)
• Anticoagulation during orthopedic surgery

Contraindications

• Hypersensitivity to drug
• Acute coronary syndrome
• Active major bleeding or unstable angina in patients not undergoing PCTA

Precautions

Use cautiously in:
• renal impairment, severe hepatic dysfunction, bacterial endocarditis, cerebrovascular accident, severe hypertension, heparin-induced thrombocytopenia, thrombosis syndrome
• diseases associated with increased risk of bleeding
• concurrent use of other platelet aggregation inhibitors
• pregnant or breastfeeding patients
• children.

Administration

• For I.V. injection and infusion, add 5 ml of sterile water to each 250-mg vial; gently mix until dissolved. Further dilute in 50 ml of dextrose 5% in water or normal saline solution for injection to a final concentration of 5 mg/ml.
• Don't mix with other drugs.
• Don't give by I.M. route.
• Know that drug is intended for use with aspirin.

Route	Onset	Peak	Duration
I.V.	Immediate	Immediate	1-2 hr

Adverse reactions

CNS: headache, anxiety, nervousness, insomnia

CV: hypotension, hypertension, bradycardia, ventricular fibrillation

GI: nausea, vomiting, abdominal pain, dyspepsia, severe spontaneous GI bleeding

GU: urinary retention, severe spontaneous GU bleeding Hematologic: severe spontaneous bleeding

Musculoskeletal: pelvic or back pain

Other: fever, pain at injection site

Interactions

Drug-drug. Abciximab, anticoagulants (including heparin, low-molecular-weight heparins, and heparinoids), thrombolytics, ticlopidine: increased risk of bleeding

Glycoprotein IIb/IIIa inhibitors: safety and efficacy of concomitant use not established

Drug-diagnostic tests. Activated partial thromboplastin time, prothrombin time: increased

Drug-herbs. Ginkgo biloba: increased risk of bleeding

Patient monitoring

☞ Monitor blood pressure, hemoglobin, and hematocrit. Be aware that decrease in blood pressure or hematocrit may signal hemorrhagic event.
• Monitor venipuncture site closely for bleeding.

Patient teaching

☞ Instruct patient to immediately report bleeding, bruising, or tarry stools.
• Tell patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Advise family members to take classes in cardiopulmonary resuscitation.