Home Drug Guide Bivalirudin

Drug Guide

Generic Name

Bivalirudin

Brand Names Angiomax, Bivalirudin In 0.9% Sodium Chloride, Angiomax Rtu

Classification

Therapeutic: Anticoagulant, Antithrombotic

Pharmacological: Direct Thrombin Inhibitor

FDA Approved Indications

  • Prevention of blood clot formation in patients undergoing percutaneous coronary intervention (PCI)

Mechanism of Action

Bivalirudin is a directly reversible, specific, and reversible thrombin inhibitor. It binds directly to thrombin, inhibiting its activity, which prevents conversion of fibrinogen to fibrin, thereby reducing clot formation.

Dosage and Administration

Adult: Typically, a bolus dose of 0.75 mg/kg IV administered immediately before PCI, followed by an infusion of 1.75 mg/kg/hr during the procedure.

Pediatric: Not approved for pediatric use.

Geriatric: Adjusted based on renal function and clinical judgment.

Renal Impairment: Dose adjustments are recommended for patients with renal impairment, especially those with CrCl <30 mL/min.

Hepatic Impairment: Use with caution; no specific dose adjustment established.

Pharmacokinetics

Absorption: Not applicable (administered intravenously).

Distribution: Vd approximately 0.2–0.3 L/kg.

Metabolism: Metabolized by proteolytic cleavage, primarily via nonspecific plasma proteases.

Excretion: Primarily excreted unchanged by the kidneys.

Half Life: About 25 minutes in patients with normal renal function.

Contraindications

  • Active bleeding

Precautions

  • Renal impairment, increased bleeding risk, allergic reactions. Use cautiously in patients with recent surgery or trauma.

Adverse Reactions - Common

  • Bleeding (Common)
  • Back pain (Less common)

Adverse Reactions - Serious

  • Major bleeding (Less common)
  • Hypotension (Less common)
  • Anemia (Less common)

Drug-Drug Interactions

  • Other anticoagulants, antiplatelet agents, thrombolytics

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, vital signs, and coagulation parameters.

Diagnoses:

  • Risk for bleeding

Implementation: Administer as ordered, ensure proper infusion rate, monitor lab values, and observe IV site for bleeding.

Evaluation: Assess for bleeding complications, monitor coagulation status, and adjust dose based on renal function and clinical response.

Patient/Family Teaching

  • Report unusual bleeding or bruising immediately.
  • Inform about the importance of sticking to the scheduled doses and follow-up testing.
  • Avoid activities that increase bleeding risk.

Special Considerations

Black Box Warnings:

  • Significant risk of bleeding

Genetic Factors: None specified.

Lab Test Interference: May affect coagulation assays such as activated partial thromboplastin time (aPTT).

Overdose Management

Signs/Symptoms: Excessive bleeding, hypotension.

Treatment: Discontinue bivalirudin; supportive care, apply pressure to bleeding sites, and consider administration of protamine sulfate; hemodialysis has limited effect due to high protein binding.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C.

Stability: Stable until expiration date provided by manufacturer.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.