bivalirudin

Bivalirudin is a synthetic, direct thrombin inhibitor used as an anticoagulant. It binds reversibly to thrombin, inhibiting both circulating and clot-bound thrombin activity. By blocking thrombin, it reduces conversion of fibrinogen to fibrin and thrombin-induced platelet activation, and it does not require antithrombin for its effect.

The principal clinical use is during percutaneous coronary intervention (PCI), where bivalirudin provides anticoagulation during the procedure. It is especially valuable in patients with heparin-induced thrombocytopenia (HIT) or when heparin is unsuitable. It is marketed under the brand name Angiomax and may be used in other catheter-based procedures as indicated by guidelines.

Pharmacokinetics and dosing considerations: bivalirudin has a rapid onset of action when given intravenously and a short half-life of about 25 minutes in individuals with normal renal function. It is primarily cleared by proteolytic cleavage, with renal excretion contributing to elimination; thus, renal impairment necessitates dose adjustments and careful monitoring. In PCI, the drug is administered as a weight-based IV bolus followed by a continuous infusion for the procedure and, if needed, a short post-procedure period. Exact dosing regimens depend on clinical guidelines and patient factors.

Safety, contraindications, and monitoring: the main adverse effect is bleeding, including major bleeding events. Bleeding risk is increased with concurrent antithrombotic therapies. Monitoring typically includes activated partial thromboplastin time (aPTT) during therapy and activated clotting time (ACT) during PCI. Contraindications include active major bleeding and known hypersensitivity. Bivalirudin is compatible with HIT management since it does not cross-react with heparin.

Reversal and management of overdose: there is no approved specific antidote for bivalirudin. If bleeding occurs, the infusion is stopped and appropriate supportive measures are employed; due to the drug’s short half-life, effects often wane with time.