Bivalirudin Dosage

Usual Adult Dose for Angina Pectoris

For patients who do not have heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis syndrome (HITTS): 0.75 mg/kg as an IV bolus dose, followed immediately by 1.75 mg/kg/hr IV for the duration of the percutaneous coronary intervention (PCI)/percutaneous transluminal coronary angioplasty (PTCA) procedure; 5 minutes after the bolus dose, an activated clotting time (ACT) should be performed and an additional bolus of 0.3 mg/kg IV should be given if needed
-Administration of a glycoprotein IIb/IIIa inhibitor (GPI) should be considered in the event that any of the following conditions are present: decreased TIMI flow (0 to 2) or slow reflow; dissection with decreased flow; new or suspected thrombus; persistent residual stenosis; distal embolization; unplanned stent; suboptimal stenting; side branch closure; abrupt closure; clinical instability; and prolonged ischemia

For patients who have HIT/HITTS undergoing PCI:
0.75 mg/kg IV as a bolus dose, followed immediately by 1.75 mg/kg/hr IV for the duration of the procedure

For ongoing treatment post procedure:
-The infusion may be continued following PCI/PTCA for up to 4 hours post procedure at the discretion of the physician.
-In patients with ST segment elevation myocardial infarction (STEMI), continuation of the infusion at a rate of 1.75 mg/kg/hr IV following PCI/PTCA for up to 4 hours post procedure should be considered to mitigate risk of stent thrombosis.
-After 4 hours, an additional IV infusion may be initiated at a rate of 0.2 mg/kg/hr IV (low-rate infusion) for up to 20 hours, if needed.

Comments:
-This drug is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin.

Uses:
-For use as an anticoagulant in patients with unstable angina undergoing PTCA
-For use an anticoagulant in patients undergoing PCI with provisional use of GPI
-For use as an anticoagulant in patients with, or at risk of, HIT or HITTS, undergoing PCI

Usual Adult Dose for Percutaneous Coronary Intervention

For patients who do not have heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis syndrome (HITTS): 0.75 mg/kg as an IV bolus dose, followed immediately by 1.75 mg/kg/hr IV for the duration of the percutaneous coronary intervention (PCI)/percutaneous transluminal coronary angioplasty (PTCA) procedure; 5 minutes after the bolus dose, an activated clotting time (ACT) should be performed and an additional bolus of 0.3 mg/kg IV should be given if needed
-Administration of a glycoprotein IIb/IIIa inhibitor (GPI) should be considered in the event that any of the following conditions are present: decreased TIMI flow (0 to 2) or slow reflow; dissection with decreased flow; new or suspected thrombus; persistent residual stenosis; distal embolization; unplanned stent; suboptimal stenting; side branch closure; abrupt closure; clinical instability; and prolonged ischemia

For patients who have HIT/HITTS undergoing PCI:
0.75 mg/kg IV as a bolus dose, followed immediately by 1.75 mg/kg/hr IV for the duration of the procedure

For ongoing treatment post procedure:
-The infusion may be continued following PCI/PTCA for up to 4 hours post procedure at the discretion of the physician.
-In patients with ST segment elevation myocardial infarction (STEMI), continuation of the infusion at a rate of 1.75 mg/kg/hr IV following PCI/PTCA for up to 4 hours post procedure should be considered to mitigate risk of stent thrombosis.
-After 4 hours, an additional IV infusion may be initiated at a rate of 0.2 mg/kg/hr IV (low-rate infusion) for up to 20 hours, if needed.

Comments:
-This drug is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin.

Uses:
-For use as an anticoagulant in patients with unstable angina undergoing PTCA
-For use an anticoagulant in patients undergoing PCI with provisional use of GPI
-For use as an anticoagulant in patients with, or at risk of, HIT or HITTS, undergoing PCI

Renal Dose Adjustments

-No reduction in the bolus dose is recommended for any degree of renal impairment
-CrCl less than 30 mL/min: Reduce the infusion dose to 1 mg/kg/hr

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis: No change in bolus dose; however, the infusion rate should be reduced to 0.25 mg/kg/hr
Peritoneal dialysis: Data not available

Other Comments

Storage requirements:
-The manufacturer product information should be consulted.

Reconstitution/preparation techniques:
-The manufacturer product information should be consulted.

IV compatibility:
-The manufacturer product information should be consulted.

General:
-This drug is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin.