Direct Thrombin Inhibitor / PCI Pregnancy: No data available in pregnant women; animal reproduction studies (rats/rabbits) up to 1.6–3.2x the maximum recommended human dose revealed no evidence of fetal harm

Bivalirudin (PCI Anticoagulation)

Brand names: Angiox

Bivalirudin is a direct thrombin inhibitor given intravenously as procedural anticoagulation during percutaneous coronary intervention.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.75 mg/kg intravenous bolus, followed immediately by a 1.75 mg/kg/h intravenous infusion for the duration of the procedure. Five minutes after the bolus, perform an activated clotting time (ACT) and give an additional 0.3 mg/kg bolus if needed

Route: intravenous (bolus then continuous infusion)

Frequency: single bolus, then continuous infusion for the duration of the PCI procedure; in STEMI, consider extending the 1.75 mg/kg/h infusion for up to 4 hours post-procedure

Studied only in patients receiving concomitant aspirin. Reconstitute to a final concentration of 5 mg/mL and adjust the administered volume to patient weight (see label dosing table). Do not administer in the same IV line as alteplase, amiodarone, amphotericin B, chlorpromazine, diazepam, dobutamine, prochlorperazine, reteplase, streptokinase or vancomycin. Acute stent thrombosis observed more frequently in STEMI patients undergoing primary PCI — patients should remain monitored for at least 24 hours.

Dose adjustments

Renal

No reduction in the bolus dose for any degree of renal impairment. Maintenance infusion: if creatinine clearance <30 mL/min (Cockcroft-Gault), reduce infusion to 1 mg/kg/h; in patients on haemodialysis, reduce infusion to 0.25 mg/kg/h. Monitor anticoagulant status in renal impairment

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Active major bleeding
Hypersensitivity (e.g. anaphylaxis) to bivalirudin or its components

Side effects

Bleeding (most common, >2%)
Major bleeding events (intracranial, retroperitoneal, overt bleeding with haemoglobin fall or requiring transfusion)
Acute stent thrombosis (in STEMI patients undergoing primary PCI)
Hypersensitivity/anaphylaxis
Immunogenicity (potential antibody formation)

Interactions

Heparin, warfarin, thrombolytics or GPIs (glycoprotein IIb/IIIa inhibitors) — increased risk of major bleeding events with concomitant use

Clinical monograph

How it works

It binds directly and reversibly to thrombin, inhibiting both circulating and clot-bound thrombin to prevent fibrin formation and platelet activation during the procedure.

Prescribing in practice

As an anticoagulant it carries a bleeding risk, and acute stent thrombosis has been reported around primary PCI, so it is used within a defined antiplatelet strategy by the procedural team.
It is renally cleared, so the infusion requires adjustment in significant renal impairment.
It has a short half-life, allowing anticoagulation to subside relatively quickly after the infusion ends.

Monitoring

Monitor for bleeding and haemodynamic status during and after the procedure, with renal function informing dosing.

Counselling the patient

This anticoagulant is given by drip during your angioplasty by the cardiology team.
Report any bleeding, bruising or chest pain after the procedure.
The team will monitor the access site and your heart closely afterwards.

Evidence & guidelines

Bivalirudin has been compared with heparin plus glycoprotein IIb/IIIa inhibitors in PCI trials such as HORIZONS-AMI, informing its use as procedural anticoagulation.

Reference: HORIZONS-AMI Trial (Stone et al. NEJM 2008); ESC STEMI 2023; NICE NG185; SPC Angiox; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways