Interactions between warfarin and Angiomax (bivalirudin)
warfarin and bivalirudin (Major Drug-Drug)
GENERALLY AVOID: The concomitant administration of bivalirudin and other anticoagulants may increase the risk of bleeding complications due to additive or synergistic effects on the clotting cascade. In clinical trials, the use of bivalirudin with heparin or warfarin in patients undergoing PTCA was associated with increased risks of major bleeding events. According to the manufacturer, results from drug interaction studies do not suggest pharmacodynamic interactions with low molecular weight heparin (LMWH). However, data are limited, and patients in clinical trials receiving LMWH were taken off the drug at least 8 hours prior to PTCA and administration of bivalirudin.
MANAGEMENT: Until further data are available, coadministration of bivalirudin and all anticoagulants should be undertaken with caution and only after thorough assessment of risks and benefits. Close clinical and laboratory observation for bleeding complications is recommended.
