Indications

Bivalirudin is indicated for: Anticoagulant in Patients Undergoing PTCA/PCI or PCI with HITS/HITTS Unstable Angina/Non-ST-Elevation MI (Off-label) STEMI Undergoing Primary PCI (Off-label) Heparin-induced Thrombocytopenia

Composition

Pharmacology

Bivalirudin directly inhibits thrombin by specifically binding both to the catalytic site and to the anion-binding exosite of circulating and clot-bound thrombin. Thrombin is a serine proteinase that plays a central role in the thrombotic process, acting to cleave fibrinogen into fibrin monomers and to activate Factor XIII to Factor XIIIa, allowing fibrin to develop a covalently cross-linked framework which stabilizes the thrombus; thrombin also activates Factors V and VIII, promoting further thrombin generation, and activates platelets, stimulating aggregation and granule release. The binding of bivalirudin to thrombin is reversible as thrombin slowly cleaves the bivalirudin-Arg3-Pro4 bond, resulting in recovery of thrombin active site functions. In in vitro studies, bivalirudin inhibited both soluble (free) and clot-bound thrombin, was not neutralized by products of the platelet release reaction, and prolonged the activated partialthromboplastin time (aPTT), thrombin time (TT), and prothrombin time (PT) of normal human plasma in a concentration-dependent manner. The clinical relevance of these findings is unknown.

Dosage & Administration

PCI/PTCA : IV Bolus dose of 0.75 mg/kg followed by an infusion of 1.75 mg/kg/h for duration of PCI procedure. Five minutes after bolus dose, obtain ACT and administer additional bolus of 0.3 mg/kg if indicated. HIT/HITTS : IV Bolus dose of 0.75 mg/kg, followed by a continuous infusion at a rate of 1.75 mg/kg/h for the duration of the procedure. Continuation of Therapy : IV Infusion may be continued for up to 4 h post-procedure as indicated. After 4 h, an additional IV infusion of 0.2 mg/kg/h for up to 20 h may be given if needed. Concomitant Therapy : Bivalirudin is intended for concurrent use with aspirin (300 to 325 mg/day). Renal Function Impairment : CrCl 30 to 50 mL/min: Administer infusion at rate of 1.75 mg/kg/h. CrCl less than 30 mL/min: Reduce infusion rate to 1 mg/kg/h. Hemodialysis: Reduce infusion rate to 0.25 mg/kg/h. No reduction in bolus dose needed.

Contraindications

Bivalirudin is contraindicated in patients with: Active major bleeding & Hypersensitivity (e.g., anaphylaxis) to Bivalirudin or its components

Side Effects

Bleeding, Body as a Whole: fever,infection, sepsis; Cardiovascular: hypotension, syncope, vascular anomaly,ventricular fibrillation; Nervous: cerebral ischemia, confusion, facialparalysis; Respiratory: lung edema; Urogenital: kidney failure, oliguria.

Pregnancy & Lactation

Pregnancy Category B. No adequate and well-controlled studies in pregnant women. As animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Bivalirudin is intended for use with aspirin . Because of possible adverse effects on the neonate and the potential for increased maternal bleeding, particularly during the third trimester, Bivalirudin and aspirin should be used together during pregnancy only if clearly needed. Nursing Mothers : It is not known whether bivalirudin is excreted in human milk. As many drugs are excreted in human milk, caution should be exercised when Bivalirudin is administered to a nursing woman.

Precautions & Warnings

Bleeding Events : Although most bleeding associated with the use of Bivalirudin in PCI/PTCA occurs at the site of arterial puncture, hemorrhage can occur at any site. An unexplained fall in blood pressure or hematocrit should lead to serious consideration of a hemorrhagic event and cessation of Bivalirudin administration. Bivalirudin should be used with caution in patients with disease states associated with an increased risk of bleeding. Coronary Artery Brachy therapy : An increased risk of thrombus formation, including fatal outcomes, has been associated with the use of Bivalirudin in gamma brachytherapy. If a decision is made to use Bivalirudin during brachytherapy procedures, maintain meticulous catheter technique, with frequent aspiration and flushing, paying special attention to minimizing conditions of stasis within the catheter or vessels.

Therapeutic Class

Anti-platelet drugs

Storage Conditions

Store at temperature not exceeding 30º C in a dry place. Do not freeze. Keep out of reach of children