Drug Action
Bivalirudin, a hirudin analogue, is a thrombin inhibitor.
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Drug reference
Bivalirudin, a hirudin analogue, is a thrombin inhibitor.
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Unstable angina or non-ST-segment elevation myocardial infarction in patients planned for urgent or early intervention (in addition to aspirin and clopidogrel) ▶INITIALLY BY INTRAVENOUS INJECTION ▶Adult: Initially 100 micrograms/kg, then (by intravenous infusion) 250 micrograms/kg/hour (for up to 72 hours in medically managed patients) Unstable angina or non-ST-segment elevation myocardial infarction (in addition to aspirin and clopidogrel) in patients proceeding to percutaneous coronary intervention or coronary artery bypass surgery without cardiopulmonary bypass ▶INITIALLY BY INTRAVENOUS INJECTION ▶Adult: Initially 100 micrograms/kg for 1 dose, then (by intravenous injection) 500 micrograms/kg for 1 dose, then (by intravenous infusion) 1.75 mg/kg/hour for duration of procedure; (by intravenous infusion) reduced to 250 micrograms/kg/hour for 4–12 hours as necessary following percutaneous coronary intervention, for patients proceeding to coronary artery bypass surgery with cardiopulmonary continued → bypass, discontinue intravenous infusion 1 hour before procedure and treat with unfractionated heparin Anticoagulation in patients undergoing percutaneous coronary intervention including patients with ST- Cardiovascular system segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (in addition to aspirin and clopidogrel) ▶INITIALLY BY INTRAVENOUS INJECTION ▶Adult: Initially 750 micrograms/kg, followed immediately by (by intravenous infusion) 1.75 mg/kg/hour during procedure and for up to 4 hours after procedure, then (by intravenous infusion) reduced to 250 micrograms/kg/hour for a further 4–12 hours if necessary
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Bleeding (active). bleeding disorders. hypertension (severe). subacute bacterial endocarditis
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Brachytherapy procedures. previous exposure to lepirudin (theoretical risk from lepirudin antibodies)
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NICE decisions ▶Bivalirudin for the treatment of ST-segment elevation myocardial infarction (July 2011) NICE TA230 Bivalirudin (Angiox ®) in combination with aspirin and clopidogrel is recommended for the treatment of adults with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. www.nice.org.uk/guidance/ta230 Scottish Medicines Consortium (SMC) decisions SMC No. 516/08 The Scottish Medicines Consortium has advised (December 2008) that bivalirudin (Angiox ®) is accepted for restricted use within NHS Scotland for adults with acute coronary syndromes planned for urgent or early intervention who would have been considered for treatment with unfractionated heparin in combination with a glycoprotein IIb/IIIa inhibitor; it should not be used as an alternative to heparin alone. SMC No. 638/10 The Scottish Medicines Consortium has advised (September 2010) that bivalirudin (Angiox ®) is accepted for restricted use within NHS Scotland as an anticoagulant in adults undergoing percutaneous coronary intervention who would have been considered for treatment with unfractionated heparin in combination with a glycoprotein IIb/IIIa inhibitor; it should not be used as an alternative to heparin alone.
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→Appendix 1: bivalirudin
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▶Common or very common Procedural complications. skin reactions ▶Uncommon Anaemia. headache. hypersensitivity. hypotension. nausea. shock. thrombocytopenia ▶Rare or very rare Arrhythmias. cardiac tamponade. chest pain. compartment syndrome. dyspnoea. embolism and thrombosis. intracranial haemorrhage. pain. vascular disorders. vomiting
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Manufacturer advises avoid unless potential benefit outweighs risk—no information available.
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Manufacturer advises caution—no information available.
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Avoid if eGFR less than 30 mL/minute/1.73 m2. Dose adjustments ▶When used for percutaneous coronary intervention Reduce rate of infusion to 1.4 mg/kg/hour if eGFR 30–60 mL/minute/1.73 m2 and monitor blood clotting parameters.
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For intravenous infusion (Angiox ®), give continuously in Glucose 5% or Sodium chloride 0.9%. Reconstitute each 250-mg vial with 5 mL water for injections then withdraw 5 mL and dilute to 50 mL with infusion fluid.
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There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion ▶Bivalirudin (Non-proprietary) Bivalirudin 250 mg Bivalirudin 250mg powder for concentrate for solution for infusion vials | 1 vial P £175.00 (Hospital only) | 5 vial P £875.00 (Hospital only)
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Initially 100 micrograms/kg, then (by
First-line fragment. Read the complete Indications and Dose section above.
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Initially 100 micrograms/kg for 1 dose, then (by
First-line fragment. Read the complete Indications and Dose section above.
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Initially 750 micrograms/kg, followed
First-line fragment. Read the complete Indications and Dose section above.
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