The study cohort comprised 73 patients with renal dysfunction who received bivalirudin for suspected hit with or without acute coronary syndrome. Bivalirudin initial dosing anticoagulation services. Bivalirudin should be administered with optimal antiplatelet therapy aspirin plus clopidogrel. Renal clearance of bivalirudin is decreased in patients with moderate to severe renal impairment or dialysisdependent renal failure. Bivalirudin reversibly binds thrombin, free as well as clot bound, at the catalytic site and the anionbinding exosite, thereby preventing the formation and activation of. Bivalirudin has a halflife of approximately 25 minutes and a response that is linearly proportional to its dosing, with coagulation parameters returning to baseline approximately 1 to 2 hours after its discontinuation in patients with normal renal function. Evaluation of pretest clinical score 4 ts for the diagnosis of heparininduced thrombocytopenia in two clinical settings. Some of the brands for bivalirudin might be better known than bivalirudin itself. Effient prasugrel dose, indications, adverse effects.
In patients with normal renal function, the plasma halflife is 25 minutes, whereas in hemodialysis patients it is 3. Angiomax bivalirudin dose, indications, adverse effects. When treating hit, bivalirudin should be continued until the platelet count normalizes. Bivalirudin dosing adjustments for reduced renal function with or.
An unexplained fall in blood pressure or hematocrit, or any unexplained symptom, should lead to serious consideration of a hemorrhagic. The offlabel dose of bivalirudin for managing hit is suggested as 0. Dosing is adjusted for patients with renal insufficiency, and a quick reference table is provided below using a standard concentration of 250 mg100 ml. The disposition of bivalirudin was studied in ptca patients with mild, moderate and severe renal impairment.
Uconn health john dempsey hospital 1 bivalirudin angiomax dosing table bivalirudin is a direct thrombin inhibitor, and it is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention pci. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal impairment. Bivalirudin dosing adjustments for reduced renal function. Bivalirudin for injection has been studied only in patients receiving concomitant aspirin. Medscape indicationspecific dosing for angiomax bivalirudin, frequency based adverse effects. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The infusion dose of bivalirudin may need to be reduced, and anticoagulant status monitored in patients with renal impairment. At the time our hospitals bivalirudin dosing protocol was created and implemented there was limited data available for dosing bivalirudin in ecmo patients and it was felt that more conservative dose adjustments where the actual change was less than the predicted was preferable so we were not overanticoagulating our patients. All other uses including for surgical proceduresintraoperative use, call anticoagulation service. Bivalirudin 832 din in severe renal dysfunction is prolonged to about 1 h, and in the setting of dialysisdependent renal failure, the halflife approaches 4 h. Patients with moderate renal impairment 30 to 59 mlmin should receive an infusion of 1. Angiomax bivalirudin dosing, indications, interactions.
Bivalirudin for treating heparin induced thrombocytopenia. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal. Bivalirudin see appendix a for dosing heparin induced thrombocytopenia hit treatment page 1 of 7. The study included 64 patients with varying degrees of renal dysfunction who had received bivalirudin for at least 48 hours. Reduce the bivalirudin infusion dose and monitor anticoagulant status more frequently in patients with a crcl less than 30 mlminute. Bivalirudin is fda approved for use in patients with unstable angina undergoing pci with or. The information contained in the truven health micromedex products as delivered by goodrx is intended as an educational aid only. The authors make no claims of the accuracy of the information contained herein. Angiomax bivalirudin dosing, indications, interactions, adverse. Dose reduction is warranted in renal insufficiency table 100. Patients with renal impairment should be carefully. Dailymed bivalirudin injection, powder, lyophilized, for. The clearance of bivalirudin was reduced approximately 21% in patients with moderate and severe renal impairment and was reduced approximately 70% in dialysisdependent patients see clinical pharmacology 12.
Approximately 20% of unchanged drug is cleared via the kidney, and the remainder presumably undergoes proteolysis intracellularly. Heparin induced thrombocytopenia hit treatment page 1 of 7. The recommended dose of angiomax is an intravenous bolus dose of 0. The renal drug handbook the st georges hospital, adult critical.
Bivalirudin is renally cleared, in addition to proteolytic cleavage in the blood. Use caution in creatinine clearance 3050 mlminute and use is contraindicated in creatinine clearance webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Elimination of bivalirudin is through a combination of renal excretion and proteolytic. Pdr drug summaries are concise pointofcare prescribing, dosing and administering information to help phsyicans more efficiently and accurately prescribe in their practice pdr s drug summaries are available free of charge and serve as a great resource for us based mds, dos, nps and pas in patient practice. Pathology consultation on monitoring direct thrombin inhibitors. No reduction in the bolus dose is needed for any degree of renal impairment.
The bolus dose should not be changed from the posology described under acs or pci above. The disposition of bivalirudin was studied in ptca patients with mild and moderate renal function and in patients with severe renal function. Dosing is adjusted for patients with renal insufficiency, and a quick. The clearance of bivalirudin is dependent on renal function but independent of dose and gender. This guideline outlines the use of bivalirudin as an anticoagulant during extracorporeal membrane oxygenation. Anticoagulation with bivalirudin during cardiopulmonary. Bivalirudin does not bind to plasma proteins other than thrombin or to red blood cells. Bivalirudin is a generic medicine name and there are several brands available for it. Initial dosing in patients with renal dysfunction, including those on hemodialysis, is unclear. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. No reduction required for any degree of renal impairment.
Bivalirudin is a 20 amino acid long synthetic peptide with thrombinspecific anticoagulant properties. Each vial contains 250 mg bivalirudin, equivalent to an average of 275 mg of bivalirudin trifluoroactetate, 125 mg mannitol, and sodium hydroxide to adjust the ph to 56 equivalent of approximately 12. Weightbased bivalirudin protocol for heparin induced. Lo gk, juhl d, warkentin te, sigouin cs, eichler p, greinacher a. The infusion dose of bivalirudin for injection may need to be reduced, and anticoagulant status monitored in patients with renal impairment. The information on dosage adjustments in renal impairment given in this book is based on. Safety and efficacy have not been established in patients younger than 18 years. Bivalirudin dosing varies significantly in renal dysfunction. It has been found to be effective in patients requiring treatment of thrombosis, as well as those needing anticoagulation during cardiopulmonary bypass, extracorporeal life. Angiomax has been studied only in patients receiving concomitant aspirin. Bivalirudin, a direct thrombin inhibitor, is a useful alternative to heparin for anticoagulation in infants and children.
We aimed at evaluating its safety and its optimal dosing for ecmo. Renal dose adjustmentsno reduction in the bolus dose is recommended for any degree of renal impairmentcrcl less than 30 mlmin. Patients with renal dysfunction patients with severe hypertension patients with a baseline aptt ratio 1. Angiomax is supplied as a sterile white lyophilized cake, in singledose vials. If the pharmacy thats willing to deliver medicines to your home doesnt have bivalirudin in stock, you. The use of bivalirudin in patients with renal impairment. The clearance of bivalirudin was reduced approximately 20% in patients with moderate and severe renal impairment and was reduced approximately 80% in dialysisdependent patients. The recommended dose of bivalirudin for injection is an intravenous bolus dose of 0. The dosing presented below is a guide to aid in the initiation of bivalirudin infusion. In adults with normal renal function, bivalirudin has a clearance of. Therapeutic monitoring of warfarin while on bivalirudin. Bivalirudin is cleared by a combination of renal elimination and intravascular proteolysis, with renal elimination thought to be the major route of clearance.
Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. A prospective trial comparing bivalirudin with highdose heparin in 1261 patients. It is not intended as medical advice for individual conditions or treatment. Bivalirudin is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage, with a halflife in patients with normal renal function of 25 minutes. Costeffectiveness of anticoagulants for suspected heparininduced.