Bivalirudin
Also known as: Angiomax, Angiox, BG-8967, Bivalirudin, Hirulog, PPACK analogue
Source Bivalirudin at Peptiology
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Summary
Bivalirudin is a synthetic 20‑amino‑acid peptide anticoagulant used intravenously to prevent clot formation during percutaneous coronary intervention and in patients with unstable angina or non‑ST‑elevation myocardial infarction.
Mechanism of Action
Binds to the active site and exosite I of thrombin, blocking conversion of fibrinogen to fibrin and inhibiting thrombin-mediated platelet activation.
Routes of Administration
Goals & Uses
- Prevention of acute stent thrombosisTherapeuticHigh
- Management of heparin-induced thrombocytopenia (HIT)AnticoagulationHigh
- Anticoagulation during percutaneous coronary intervention (PCI)AnticoagulationHigh
- Anticoagulation during ECMOAnticoagulationLow
- Reduction of bleeding complications in ACSHemostasisHigh
- Anticoagulation during cardiac surgery (off-pump/CABG)AnticoagulationModerate
- Anticoagulation during PCIProceduralHigh
Contraindications
- Severe renal impairment (GFR <30 mL/min) without dose adjustmentRenalModerate
- Known hypersensitivity to bivalirudin or any excipientsAllergyHigh
- Active major bleedingHemorrhagic RiskHigh
- Severe hypersensitivity to bivalirudin or hirudin analogsAllergy/ImmunologyHigh
Adverse Effects
- Injection site reactionsLocalUncommon
- Hypersensitivity/anaphylaxisImmunologicalRare
- ThrombocytopeniaHematologicRareLow platelet count
- Acute stent thrombosisThromboticUncommon
- HypotensionCardiovascularUncommonLow blood pressure
- Nausea/vomitingGastrointestinalUncommon
- Allergic reactions (rash, urticaria)ImmuneRare
- BleedingHematologicCommonAbnormal bleeding or hemorrhage
- Bleeding (minor and major)HemorrhagicCommon
Drug Interactions
- Antiplatelet agents (e.g., clopidogrel, aspirin)Moderate
- WarfarinModerate
- Thrombolytics (e.g., alteplase, tenecteplase)High
- Glycoprotein IIb/IIIa inhibitors (e.g., abciximab, eptifibatide)Moderate
- Other anticoagulants (e.g., heparin, warfarin, DOACs)High
- Low molecular weight heparins (LMWHs)High
- Unfractionated HeparinHigh
Population Constraints
- PregnancyReproductive SafetyRelative
- Renal impairmentOrgan ImpairmentRelative
- Pediatric patientsAgeRelative
- Elderly patientsAgeRelative
Regulatory Status
- European UnionApprovedApproved: Anticoagulation during PCI, Unstable anginaAuthorized under similar indications as US.
- United StatesApprovedApproved: Anticoagulation during percutaneous coronary interventionMarketed as Angiomax.
- United KingdomApprovedApproved: Anticoagulation in adults undergoing PCI, STEMI patients undergoing primary PCIRetained EU approval post-Brexit; marketed as Angiox in the UK.
FDA‑approved in 2000 (Angiomax) for use in percutaneous coronary intervention; also approved in the EU and Canada.
Evidence & Sources
No sources recorded yet.
Frequently Asked Questions
What is Bivalirudin?
Bivalirudin is a synthetic 20‑amino‑acid peptide anticoagulant used intravenously to prevent clot formation during percutaneous coronary intervention and in patients with unstable angina or non‑ST‑elevation myocardial infarction.
What is Bivalirudin used for?
Bivalirudin is educationally associated with: Prevention of acute stent thrombosis, Management of heparin-induced thrombocytopenia (HIT), Anticoagulation during percutaneous coronary intervention (PCI), Anticoagulation during ECMO, Reduction of bleeding complications in ACS, Anticoagulation during cardiac surgery (off-pump/CABG), Anticoagulation during PCI. Educational only — not medical advice.
How is Bivalirudin administered?
Recorded routes of administration: Intravenous, Subcutaneous.
What are the potential side effects of Bivalirudin?
Reported adverse effects include: Injection site reactions, Hypersensitivity/anaphylaxis, Thrombocytopenia, Acute stent thrombosis, Hypotension, Nausea/vomiting, Allergic reactions (rash, urticaria), Bleeding, Bleeding (minor and major). This list is not exhaustive — consult a qualified clinician.
Who should avoid Bivalirudin?
Recorded contraindications: Severe renal impairment (GFR <30 mL/min) without dose adjustment, Known hypersensitivity to bivalirudin or any excipients, Active major bleeding, Severe hypersensitivity to bivalirudin or hirudin analogs. Consult a qualified clinician before use.