In adults with normal renal function, bivalirudin has a clearance of. Weightbased bivalirudin protocol for heparin induced. Bivalirudin reversibly binds thrombin, free as well as clot bound, at the catalytic site and the anionbinding exosite, thereby preventing the formation and activation of. Angiomax is supplied as a sterile white lyophilized cake, in singledose vials. It has been evaluated as an alternative to unfractionated and lowmolecularweight heparins in the settings of percutaneous coronary intervention pci and acute coronary syndrome acs. Dosing is adjusted for patients with renal insufficiency, and a quick. Bivalirudin initial dosing anticoagulation services.
Angiomax bivalirudin dose, indications, adverse effects. Bivalirudin 95 bleomycin 96 bortezomib 97 bosentan 98 bromocriptine 99 budesonide 100 bumetanide 101. Bivalirudin side effects, dosage, interactions drugs. Bivalirudin is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage, with a halflife in patients with normal renal function of 25 minutes. An unwanted blood clot can occur with certain heart or blood vessel conditions bivalirudin is used to prevent blood clots in people with severe chest pain or other conditions who are undergoing a procedure called angioplasty to open blocked arteries. Evaluation of dose requirements for prolonged bivalirudin. Renal dose adjustmentsno reduction in the bolus dose is recommended for any degree of renal impairmentcrcl less than 30 mlmin. Patients with renal dysfunction patients with severe hypertension patients with a baseline aptt ratio 1.
Data sources include ibm watson micromedex updated 28 feb 2020, cerner multum updated 2 mar 2020, wolters kluwer updated. Dose reduction is warranted in renal insufficiency table 100. Find patient medical information for bivalirudin in 0. The information contained in the truven health micromedex products as delivered by goodrx is intended as an educational aid only. Eighteen patients older than 18 years who were admitted to the. Bivalirudin in plasma and urine was assayed with a newly developed, highly specific liquid chromatography. No reduction in the bolus dose is needed for any degree of renal impairment. Bivalirudin primarily undergoes dual elimination via proteolytic cleavage and renal elimination, and requires dose adjustment in the setting of severe renal dysfunction. Therapeutic monitoring of warfarin in patients on bivalirudin. At the time our hospitals bivalirudin dosing protocol was created and implemented there was limited data available for dosing bivalirudin in ecmo patients and it was felt that more conservative dose adjustments where the actual change was less than the predicted was preferable so we were not overanticoagulating our patients. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Bivalirudin drug information indications, dosage, side.
Bivalirudin is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage, with a halflife in patients with normal renal function of 25 min. Recombinant hirudin an overview sciencedirect topics. Each vial contains 250 mg bivalirudin, equivalent to an average of 275 mg of bivalirudin trifluoroactetate, 125 mg mannitol, and sodium hydroxide to adjust the ph to 56 equivalent of approximately 12. Bivalirudin see appendix a for dosing heparin induced thrombocytopenia hit. Renal clearance of bivalirudin is decreased in patients with moderate to severe renal impairment or dialysisdependent renal failure.
Given the body of supportive data, bivalirudin is likely to continue to figure prominently as a reliable and efficient anticoagulation strategy. Use caution in creatinine clearance 3050 mlminute and use is contraindicated in creatinine clearance book is available from the british library. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal. The renal drug handbook the st georges hospital, adult critical. Following the withdrawal of lepirudin in 2012 we needed to establish inhouse therapeutic ranges and dosing schedules for both dti. The second study enrolled 8 volunteers with severe renal impairment who received a bivalirudin bolus of 1 mgkg, followed by an infusion of 0. Dosing guidelines for varying degrees of renal impairment are stated accordingly. Bivalirudin is renally cleared, in addition to proteolytic cleavage in the blood. Bivalirudin has a halflife of approximately 25 minutes and a response that is linearly proportional to its dosing, with coagulation parameters returning to baseline approximately 1 to 2 hours after its discontinuation in patients with normal renal function. Bivalirudin wisconsin alzheimers disease research center. Bivalirudin is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage, with a halflife of 25 min in patients with normal renal function 27. Closely monitor act in patients with renal impairment.
Angiomax bivalirudin dosing, indications, interactions. Each vial contains 250 mg bivalirudin, equivalent to an average of 275 mg of bivalirudin trifluoroacetate, 125 mg mannitol, and sodium hydroxide to adjust the ph to 5. Bivalirudin dosing adjustments for reduced renal function with or without hemodialysis in the management of heparininduced thrombocytopenia. Dosing is adjusted for patients with renal insufficiency, and a quick reference table is provided below using a standard concentration of 250 mg100 ml. The clearance of bivalirudin was reduced approximately 21% in patients with moderate and severe renal impairment and was reduced approximately 70% in dialysisdependent patients see clinical pharmacology 12. Safety and efficacy have not been established in patients younger than 18 years. Bivalirudin, heparin comparable after pci with renal. Bivalirudin, heparin comparable after pci with renal impairment. Angiomax has been studied only in patients receiving concomitant aspirin.
Uconn health john dempsey hospital 1 bivalirudin angiomax dosing table bivalirudin is a direct thrombin inhibitor, and it is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention pci. The infusion dose of bivalirudin for injection may need to be reduced, and anticoagulant status monitored in patients with renal impairment. The disposition of bivalirudin was studied in ptca patients with mild, moderate and severe renal impairment. Background bivalirudin, as compared with heparin and glycoprotein iibiiia inhibitors, has been shown to reduce rates of bleeding and death in patients undergoing primary percutaneous coronary inte.
Costeffectiveness of anticoagulants for suspected heparin. Patients with moderate renal impairment 30 to 59 mlmin should receive an infusion of 1. Physiology, pharmacology, and clinical application michael s. Bivalirudin does not bind to plasma proteins other than thrombin or to red blood cells.
This guideline outlines the use of bivalirudin as an anticoagulant during extracorporeal membrane oxygenation. The disposition of bivalirudin was studied in ptca patients with mild and moderate renal function and in patients with severe renal function. Angiomax reference guide for safe and effective use from the american society of healthsystem pharmacists ahfs di. For renally excreted drugs with a narrow therapeutic index, the total daily maintenance dose may be reduced either by decreasing the dose or by increasing the dosing interval, or sometimes by a combination of both.
Elimination of bivalirudin is through a combination of renal excretion and proteolytic. Dailymed bivalirudin injection, powder, lyophilized, for. Evaluation of bivalirudin treatment for heparininduced. Learn how to pronounce the drugs name, its indications, dosage, how to take, when. Bivalirudin has renal excretion but also a unique metabolic elimination process.
Heparin induced thrombocytopenia hit treatment page 1 of 7. Bivalirudin started during emergency transport for primary. The information on dosage adjustments in renal impairment given in this book is based on. It is not intended as medical advice for individual conditions or treatment. Bivalirudin dosing adjustments for reduced renal function. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal impairment. Argatroban and bivalirudin are two direct thrombin inhibitors dti employed to treat heparininduced thrombocytopenia hit. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The recommended dose of angiomax is an intravenous bolus dose of 0. Bivalirudin should be administered with optimal antiplatelet therapy aspirin plus clopidogrel. Bivalirudin for injection is supplied as a sterile white lyophilized cake, in singledose vials. Bivalirudin dosing adjustments for reduced renal function with or. Reduce the bivalirudin infusion dose and monitor anticoagulant status more frequently in patients with a crcl less than 30 mlminute. The use of bivalirudin in patients with renal impairment.
A catalogue record for this book is available from the british library. Bivalirudin 832 din in severe renal dysfunction is prolonged to about 1 h, and in the setting of dialysisdependent renal failure, the halflife approaches 4 h. Welcome to the fifth edition of the renal drug handbook. Practical guidelines for argatroban and bivalirudin in. Patients with moderate renal impairment 3059 mlmin should receive an infusion of 1. Bivalirudin for treating heparin induced thrombocytopenia. The infusion dose of angiomax may need to be reduced, and anticoagulant status monitored in patients with renal impairment. Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. To evaluate the safety, effectiveness, and dosing of bivalirudin for treatment of heparininduced thrombocytopenia hit in critically ill patients with hepatic andor renal dysfunction. The study cohort comprised 73 patients with renal dysfunction who received bivalirudin for suspected hit with or without acute coronary syndrome. Bivalirudin is an anticoagulant thrombin inhibitor that helps prevent the formation of blood clots. When treating hit, bivalirudin should be continued until the platelet count normalizes. An unwanted blood clot can occur with certain heart or blood vessel conditions.
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