Bivalirudin

How it works

It is a direct, reversible inhibitor of both circulating and clot-bound thrombin, blocking thrombin-catalysed conversion of fibrinogen to fibrin.

Prescribing in practice

• Bleeding is the main hazard and dosing must be adjusted in renal impairment because clearance is partly renal.
• It is an alternative to heparin during percutaneous coronary intervention, particularly where heparin-induced thrombocytopenia is a concern.
• Acute stent thrombosis has been reported, so antiplatelet cover and post-procedure management are important.

Monitoring

Monitor for bleeding and assess renal function, with activated clotting time used periprocedurally where appropriate.

Counselling the patient

• This is an intravenous blood thinner given around your heart procedure.
• Report any bleeding, bruising or chest pain after the procedure.
• Continue prescribed antiplatelet medicines as directed.

Evidence & guidelines

Randomised trials in percutaneous coronary intervention have compared bivalirudin with heparin-based regimens, informing its use as a procedural anticoagulant.