Biva

Indications

Bivalirudin is an injectable blood thinner (anticoagulant) used in hospital during procedures to open narrowed heart arteries, known as percutaneous coronary intervention (PCI) or angioplasty with stenting. It is also used in some patients with acute coronary syndromes, and in people who have developed heparin-induced thrombocytopenia (a reaction to Heparin) and need heart procedures.

How It Works

Bivalirudin directly blocks thrombin, the key enzyme that turns fibrinogen into fibrin threads to form a clot. It acts on thrombin that is free in the blood as well as thrombin already bound to a clot. Its effect starts at once and wears off within about an hour after stopping, which helps control bleeding risk.

Dosage and Administration

Bivalirudin is given by a doctor or nurse as an injection into a vein followed by a continuous infusion, in a hospital catheter laboratory or cardiac unit. The dose is based on body weight and kidney function and is set by the medical team, as prescribed. It is usually given together with Aspirin and another antiplatelet medicine.

Interactions

Other medicines that affect clotting or platelets, such as Heparin, Warfarin, Aspirin, Clopidogrel, Ticagrelor, glycoprotein IIb/IIIa inhibitors and clot-dissolving medicines, increase the risk of bleeding. The medical team will monitor and adjust treatment.

Contraindications

• Active major bleeding or a bleeding disorder.
• Severe uncontrolled high blood pressure.
• Subacute bacterial endocarditis (infection of the heart lining).
• Severe kidney impairment, or dialysis dependence (in some situations).
• Allergy to Bivalirudin or hirudins.

Side Effects

Bleeding is the main side effect, most often at the puncture site in the groin or wrist, but it can occur elsewhere. Other effects include bruising, nausea, low blood pressure, back pain, headache and, rarely, allergic reactions.

Tell the medical staff immediately if you notice bleeding or swelling at the puncture site, blood in urine or stools, vomiting blood, chest pain, severe headache, sudden weakness or difficulty speaking, or difficulty breathing.

Pregnancy and Lactation

There is limited information on use in pregnancy; it is used only if the doctor considers it clearly necessary. It is not known if it passes into breast milk; the doctor will advise on breastfeeding.

Precautions and Warnings

• Close monitoring for bleeding is needed during and after the procedure.
• Clot formation in a stent shortly after the procedure is a known risk; follow the antiplatelet treatment your doctor prescribes after discharge.
• Dose is adjusted in kidney impairment.
• Hospital-only medicine.

Overdose

Overdose increases bleeding risk. Stopping the infusion allows the effect to wear off quickly, and staff give supportive care; there is no specific antidote, but it can be removed by dialysis.

Therapeutic Class

Anticoagulant, direct thrombin inhibitor

Storage

Hospital medicine: store the unopened vials as directed on the pack, usually below 25°C. Prepared solutions are used as directed. Keep out of the reach of children.