Short-acting intravenous anticoagulant. Used during coronary angioplasty (percutaneous intervention), also in patients with heparin-induced thrombocytopenia.
Regulatory status
Approved (FDA / EMA)
Family
Direct thrombin inhibitor (hirudin analog)
Scientific evidence
High
Number of findings
2
Where it acts
Heart and blood
Also known as
bivalirudin, Angiomax, Angiox, hirulog
Regulatory status
FDA (US): Approved (2000, Angiomax) as an anticoagulant in percutaneous coronary intervention, including patients with heparin-induced thrombocytopenia.
EMA (EU): Approved (2004, Angiox) as an anticoagulant in percutaneous coronary intervention and in acute coronary syndrome.
Dose
Intravenous bolus of 0.75 mg/kg followed by an infusion of 1.75 mg/kg/h during the procedure; adjust in renal impairment (FDA Angiomax label). Hospital only.
Safety
Bleeding (the main risk), back pain, nausea, hypotension. In ST-elevation myocardial infarction, more acute stent thrombosis has been observed than with heparin. Contraindicated with significant active bleeding.
Interactions
Higher bleeding risk if combined with other anticoagulants, antiplatelets, or thrombolytics.
Effect by goal · level of evidence
Less bleeding in angioplasty for non-ST-elevation infarction
reducesHighmeta-analysis (AAA)in people
−41% major bleeding
Individual-patient-data meta-analysis of 5 RCTs (12,155 patients): major bleeding of 3.3% with bivalirudin versus 5.5% with heparin; 30-day mortality without differences (1.2% vs 1.1%).
Pooled analysis of 3 RCTs (7,612 patients): more definite stent thrombosis with bivalirudin (2.39% vs 1.06%) with no differences in mortality and no clear reduction in major bleeding.
It binds directly to thrombin, the enzyme that forms the clot, and blocks it reversibly. Unlike heparin, it does not need antithrombin. Its effect wears off in 1–2 hours when the infusion is stopped.
What the evidence says
In people
Less bleeding in angioplasty for non-ST-elevation heart attack. Individual-patient-data meta-analysis of 5 RCTs (12,155 patients): major bleeding of 3.3% with bivalirudin versus 5.5% with heparin; 30-day mortality with no differences (1.2% vs 1.1%). PubMed 37746717
Stent thrombosis in ST-elevation heart attack. Pooled analysis of 3 RCTs (7,612 patients): more definite stent thrombosis with bivalirudin (2.39% vs 1.06%) with no differences in mortality and no clear reduction in major bleeding. PubMed 25913723