bivalirudin
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 coronary angioplasty (PTCA); patients with or at risk for heparin-induced thrombocytopenia or heparin-induced thrombocytopenia and thrombosis syndrome undergoing percutaneous coronary intervention
Adults: 0.75 mg by I.V. bolus followed by 1.75 mg/kg/hour by I.V. infusion for duration of procedure. Five minutes after bolus is administered, an activated clotting time should be obtained and an additional bolus of 0.3 mg/kg should be given if needed. Continuation of infusion for up to 4 hours post-procedure is optional, and at discretion of treating physician. After 4 hours, an additional I.V. infusion may be initiated at rate of 0.2 mg/kg/hour for up to 20 hours if needed.
Dosage adjustment
• Renal impairment
• Dialysis patients
Off-label uses
• PCTA (regardless of history of unstable angina)
• Anticoagulation during orthopedic surgery
Contraindications
• Hypersensitivity to drug
• Active major bleeding
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.
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, warfarin: increased risk of bleeding
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.
Angiomax™
A specific and reversible direct thrombin inhibitor.Indications
Anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA) and percutaneous coronary intervention (PCI), especially in patients with, or at risk of, HIT/HITTS.
Adverse effects
Back or other regional pain, nausea, headache, hypotension.