II. Indications
- Patients at risk for Heparin Induced Thrombocytopenia
- Percutaneous Coronary Intervention (PCI)
- Unstable Angina or NSTEMI while awaiting PCI (off label)
III. Mechanism
- Hirudin Direct Thrombin Inhibitor
- Bivalent peptide derivatives from Salivary Gland of medicinal leaches
IV. Dosing
- Coadminister with Aspirin 325 mg orally daily
-
Percutaneous Coronary Intervention (PCI) for patients at risk for HIT
- Bolus: 0.75 mg/kg IV prior to PCI
- Next: 1.75 mg/kg/hour until PCI completed and for up to 4 hours after PCI
- Decrease to 1 mg/kg/hour if Creatinine Clearance <30 ml/min
- Decreased to 0.23 mg/kg/hour if on Hemodialysis
- Maintenance: 0.2 mg/kg/hour for up to 20 hours
-
Unstable Angina or NSTEMI while awaiting PCI (off label)
- Coadminister with Dual Antiplatelet Therapy (e.g. Aspirin and Ticagrelor)
- May be used with Glycoprotein IIB/IIIA Inhibitor
- Bolus: 0.1 mg/kg IV
- Maintenance: 0.25 mg/kg/hour until PCI
V. Safety
- Pregnancy Category B
- Unknown safety in Lactation
VI. Adverse Effects
- Major Bleeding
-
Allergic Reaction
- Serious Allergic Reactions including Anaphylaxis may occur with Hirudins
- Highest risk on Hirudin re-exposure or in GFR <30 ml/min
VII. Drug Interactions
-
Warfarin
- INR levels are inaccurate while on Bivalirudin
- Monitor Warfarin coagulation with Activated Clotting Time (ACT)
VIII. Resources
IX. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Berlioz (2023) Bivalirudin, StatPearls, Treasure Island, FL