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bivalirudin (Angiomax)
Tradename: Angiomax.
Indications:
1) prevention of thrombosis
a) anticoagulant for patients undergoing angioplasty, percutaneous coronary intervention (PCI)
b) acute coronary syndrome [2], NSTEMI [3]
c) for use after administration of aspirin plus clopidogrel
2) heparin-induced thrombocytopenia [6]
Contraindications:
- during emergency medical transport for PCI [5]
Pharmacokinetics:
1) 1/2 life of 25 minutes
Adverse effects:
- see thrombin inhibitor
Overdose
- activated prothrombin concentrate complex 50-100 units/kg IV
- hemofiltration through a polyfulfone membrane [4]
Mechanism of action:
-> direct inhibitor of thrombin
Clinical trials:
- ISAR-REACT 4 Trial
- bivalirudin alone vs heparin plus abciximab (glycoprotein IIb/IIIa inhibitor) after aspirin plus clopidogrel (600 mg) in patients undergoing PCI for NSTEMI
- bivalirudin group associated with less bleeding (2.6% vs 4.6%)
- mortality, MI & urgent revascularization similar [3]
Interactions
drug interactions
drug adverse effects of antithrombotic agent(s)
General
enzyme inhibitor
pharmaceutical anticoagulant
Properties
INHIBITS: thrombin
References
- Prescriber's Letter 8(2):11 2001
- Stone GW et al, for the ACUITY Investigators
Bivalirudin for patients with acute coronary syndromes.
N Engl J Med 2006, 355:2203
PMID: 17124018
- Bittl JA
Accounting for Acuity
N Engl J Med 2006, 355:2249
PMID: 17124024
- Kastrati A et al. for the ISAR-REACT 4 Trial Investigators.
Abciximab and heparin versus bivalirudin for non-ST-elevation
myocardial infarction.
N Engl J Med 2011 Nov 13
PMID: 22077909
http://www.nejm.org/doi/full/10.1056/NEJMoa1109596
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Steg PG et al for the EUROMAX Investigators
Bivalirudin Started during Emergency Transport for Primary PCI.
N Engl J Med. October 30, 2013
PMID: 24171490
http://www.nejm.org/doi/full/10.1056/NEJMoa1311096
- Mehta SR
Balancing Thrombotic Events and Bleeding in Primary PCI.
N Engl J Med. October 30, 2013
PMID: 24171491
http://www.nejm.org/doi/full/10.1056/NEJMe1312702
- Deprecated Reference