bivalirudin


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bivalirudin

 [bi-val´ĭroo-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.

bivalirudin

Angiomax, Angiox (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 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.

hirulog

(her-yū-log),
A synthetic thrombin inhibitor.
Synonym(s): 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.

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.

bivalirudin

A specific direct-thrombin inhibitor, a synthetic analogue of hirudin, which is found in the saliva of Hirudo medicinalis, the medicinal leech. It is better than heparin in that it has a rapid onset of action, shorter half-life, is potent, specifically binds to thrombin and is reversible.

Indications
Anticoagulant for unstable angina and percutaneous coronary interventions, especially patients with heparin induced thrombocytopenia/heparin induced thrombosis-thrombocytopenia syndrome (HIT/HITTS).
References in periodicals archive ?
Food and Drug Administration (FDA) approval for the launch of bivalirudin for injection, a generic version of The Medicines Company's Angiomax(TM).
Bivalirudin and heparin are two anticoagulant options for patients undergoing coronary stenting for ischemic heart disease.
According to the researchers, the drug can reduce rate of repeat heart attacks, as compared to bivalirudin which is more expensive.
The purpose of this study was to assess whether simulation training can improve the clinician's ability to predict the effect of bivalirudin infusion.
The bivalent DTIs include bivalirudin and lepirudin, and bind both the active site and exosite 1 of thrombin.
Bivalirudin was recently approved by the Food and Drug Administration for the treatment of certain cardiac conditions, but because it has no antidote and its use in transplantation is so new, the doctors had to develop a game plan and specific protocols in advance of the operation.
Based on results of the ACUITY trial, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMEA) recently recommended extending the indication for Angiox(R) (the trade name for bivalirudin in Europe) to adult patients with ACS planned for urgent or early intervention.
The primary end point of the study showed that benefit and risk from treatment with the antithrombotic drug bivalirudin (Angiomax) alone were similar to standard treatment with a heparin (either unfractionated heparin or low-molecular-weight heparin) plus a glycoprotein IIb/IIIa inhibitor, or to treatment with bivalirudin plus a GP IIb/IIIa inhibitor (N.
Bivalirudin was subsequently approved for use in the EU in 2004 under the trade name Angiox.
Drug: Bivalirudin dronabinol / cannabidiol, bexarotene.
Washington, June 14 (ANI): A study has found that use of bivalirudin alone improves survival in heart-attack patients compared to heparin and a glycoprotein IIb/IIIa inhibitor.
Regarding anticoagulation choice for CPB, two agents have been described: heparin and bivalirudin (5,6).