Bivalirudin (PCI Anticoagulation)

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.