bivalirudin at a glance
Medicine class
Direct thrombin inhibitor anticoagulant
Usual setting
Specialist hospital cardiac care
How it is given
Injection and infusion into a vein; never into a muscle
Main safety concern
Bleeding, particularly around the arterial puncture site
What is bivalirudin used for?
The selected UK product is licensed for adults in specialist coronary care.
Anticoagulation during percutaneous coronary intervention, including primary intervention for ST-segment elevation myocardial infarction.
Treatment of unstable angina or non-ST-segment elevation myocardial infarction when urgent or early intervention is planned.
How does bivalirudin work?
Thrombin helps make and stabilise fibrin clots and activates platelets. Bivalirudin binds directly and reversibly to free and clot-bound thrombin, temporarily reducing these actions.
bivalirudin preparations and strengths
Injection
Route: Parenteral
Strengths: 250 mg
How to take bivalirudin
Bivalirudin is prepared and given intravenously by clinicians experienced in acute coronary care or coronary procedures.
The powder must be reconstituted and diluted using aseptic technique.
The solution must be thoroughly mixed and checked for particles or discolouration.
Correct preparation, line priming and uninterrupted delivery are important because administration errors can cause inadequate anticoagulation.
Food does not affect it because it is not taken by mouth.
bivalirudin side effects
Common or expected effects
- Minor bleeding
- Bleeding or bruising around the vessel-puncture site
- Reduced haemoglobin or anaemia
- Haematoma
Get urgent medical advice
- Major or internal bleeding
- Severe allergic reaction, including anaphylaxis
- Coronary, stent or catheter thrombosis
- Intracranial bleeding
- A large or painful limb haematoma, which can rarely cause compartment syndrome
bivalirudin in pregnancy
Human pregnancy information is limited. Bivalirudin should generally be avoided unless the pregnant person's clinical condition requires it. Specialists should balance the urgent need for anticoagulation against uncertain fetal risk.
bivalirudin while breastfeeding
It is unknown whether bivalirudin passes into human milk. A specialist should assess the clinical need, alternatives and the infant's circumstances before use.
bivalirudin interactions
Other treatments that affect clotting can increase bleeding risk.
Anticoagulants, including heparin and warfarin
Concurrent use can increase bleeding risk and requires clinical and haemostasis monitoring. Bivalirudin can also temporarily increase INR in people receiving warfarin.
Antiplatelet medicines
Aspirin, clopidogrel, prasugrel, ticagrelor and glycoprotein IIb/IIIa inhibitors can add to bleeding risk.
Thrombolytic medicines
Combined effects on haemostasis can increase bleeding risk.
Common questions about bivalirudin
Answers are fully visible for fast scanning and source review.
Why is bivalirudin used during coronary angioplasty?
It suppresses thrombin while coronary vessels are being instrumented, reducing clot formation during the procedure.
Is it an anticoagulant or an antiplatelet medicine?
It is an anticoagulant that directly blocks thrombin rather than primarily blocking platelet activation.
Does it dissolve an existing blood clot?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.