{"id":1677,"date":"2023-06-25T17:29:32","date_gmt":"2023-06-25T17:29:32","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/bivalirudin\/"},"modified":"2023-06-25T19:50:32","modified_gmt":"2023-06-25T19:50:32","slug":"bivalirudin","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/bivalirudin\/","title":{"rendered":"Bivalirudin"},"content":{"rendered":"

<\/p>\n

Bivalirudin<\/h1>\n

CLINICAL USE<\/h3>\n

Anticoagulant:<\/p>\n

  • Percutaneous coronary intervention
    \n

    DOSE IN NORMAL RENAL FUNCTION<\/h3>\n

    Initially bolus of 750 mcg\/kg then an infusion of 1.75 mg\/kg\/hour<\/p>\n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :2180.3<\/li>\n
  • %Protein binding                           :0<\/li>\n
  • %Excreted unchanged in urine     : 20<\/li>\n
  • Volume of distribution (L\/kg)       :0.1<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :13\u201337 minutes\/ 57 minutes (310 minutes in dialysis patients on non-<\/li>\n
  • HD days)
    \n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n

    30\u201350 Dose as in normal renal function10\u201330 Normal bolus dose. Reduce infusion dose by 20% (1.4 mg\/kg\/hour). See \u2018Other Information\u2019<\/li>\n

  • <10           : Normal bolus dose. Reduce infusion dose by 80% and monitor ACT. See \u2018Other Information\u2019
    \n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :Unknown dialysability. Dose as for GFR <10 mL\/min<\/li>\n
  • HD                     :Dialysed. Dose as for GFR<\/li>\n
  • <10           : mL\/min<\/li>\n
  • HDF\/high flux   :Dialysed. Dose as for GFR<\/li>\n
  • <10           : mL\/min<\/li>\n
  • CAV\/VVHD      :Unknown dialysability. Dose as for GFR=10\u201329 mL\/min
    \n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Antiplatelets and anticoagulants: increased risk of bleeding<\/li>\n
  • Thrombolytics: may increase risk of bleeding complications; enhance effect of bivalirudin
    \n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    Reconstitute each 250 mg vial with 5 mL water for injection<\/p>\n

    Route<\/h4>\n

    IV<\/p>\n

    Rate of Administration<\/h4>\n

    1.75 mg\/kg\/hour<\/p>\n

    Comments<\/h4>\n

    Further dilute with 50 mL sodium chloride 0.9% or glucose 5% if for infusion<\/li>\n

  • Stable for 24 hours at room temperature
    \n

    OTHER INFORMATION<\/h4>\n<\/li>\n
  • Monitor ACT in renal impairment<\/li>\n
  • Can start bivalirudin 30 minutes after stopping unfractionated heparin and 8 hours after stopping LMWHNo known antidote Dose recommendations vary from country to country; doses above are from New Zealand<\/li>\n
  • UK doses: GFR=30\u201359 mL\/min: reduce dose by \u201420%GFR<30 mL\/min: contraindicated \u2014USA doses: Normal dose: 1 mg\/kg bolus then \u20142.5 mg\/kg infusionGFR=30\u201359 mL\/min: reduce dose by \u201420%GFR=10\u201329 mL\/min: reduce dose by \u201460%Dialysis dependent: reduce dose by \u201490%<\/li>\n
  • Lobo BL. Use of newer anticoagulants in patients with chronic kidney disease. Am J Health-Syst Pharm. 2007, Oct 1; 64: 2017\u201326:<\/li>\n
  • GFR=30\u201350 mL\/min: 1.75 mg\/kg\/hour \u2014<\/li>\n
  • GFR<30 mL\/min: 1 mg\/kg\/hour \u2014<\/li>\n
  • On haemodialysis: 0.25 mg\/kg\/hour<\/li>\n","protected":false},"excerpt":{"rendered":"

    Bivalirudin CLINICAL USE Anticoagulant: Percutaneous coronary intervention DOSE IN NORMAL<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1677","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1677","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1677"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1677\/revisions"}],"predecessor-version":[{"id":2895,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1677\/revisions\/2895"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1677"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1677"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1677"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}