Drug Interaction Report

MONITOR: The safety and efficacy of bivalirudin have not been established when used in conjunction with platelet inhibitors other than aspirin. Theoretically, the concomitant administration of bivalirudin (plus aspirin) and platelet inhibitors may increase the risk of bleeding complications due to additive or synergistic effects on the clotting cascade. However, limited data from drug interaction studies do not suggest pharmacodynamic interactions with the platelet inhibitors, ticlopidine and abciximab.

MANAGEMENT: Until further data are available, the coadministration of bivalirudin and antiplatelet agents, and possibly other agents with antiplatelet activity such as nonsteroidal anti-inflammatory drugs (NSAIDs), should probably be undertaken with caution. Close clinical and laboratory observation for bleeding complications is recommended.

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.