The infusion dose of bivalirudin for injection may need to be reduced, and anticoagulant status monitored in patients with renal impairment. Bivalirudin dosing adjustments for reduced renal function with or. A prospective trial comparing bivalirudin with highdose heparin in 1261 patients. Use caution in creatinine clearance 3050 mlminute and use is contraindicated in creatinine clearance webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Angiomax has been studied only in patients receiving concomitant aspirin. Bivalirudin dosing varies significantly in renal dysfunction. The use of bivalirudin in patients with renal impairment. Renal clearance of bivalirudin is decreased in patients with moderate to severe renal impairment or dialysisdependent renal failure. The infusion dose of bivalirudin may need to be reduced, and anticoagulant status monitored in patients with renal impairment.
If the pharmacy thats willing to deliver medicines to your home doesnt have bivalirudin in stock, you. The disposition of bivalirudin was studied in ptca patients with mild, moderate and severe renal impairment. Each vial contains 250 mg bivalirudin, equivalent to an average of 275 mg of bivalirudin trifluoroactetate, 125 mg mannitol, and sodium hydroxide to adjust the ph to 56 equivalent of approximately 12. Renal dose adjustmentsno reduction in the bolus dose is recommended for any degree of renal impairmentcrcl less than 30 mlmin. The clearance of bivalirudin was reduced approximately 21% in patients with moderate and severe renal impairment and was reduced approximately 70% in dialysisdependent patients see clinical pharmacology 12. Lo gk, juhl d, warkentin te, sigouin cs, eichler p, greinacher a.
This guideline outlines the use of bivalirudin as an anticoagulant during extracorporeal membrane oxygenation. Bivalirudin dosing adjustments for reduced renal function. The disposition of bivalirudin was studied in ptca patients with mild and moderate renal function and in patients with severe renal function. Bivalirudin, a direct thrombin inhibitor, is a useful alternative to heparin for anticoagulation in infants and children. The clearance of bivalirudin was reduced approximately 20% in patients with moderate and severe renal impairment and was reduced approximately 80% in dialysisdependent patients. The clearance of bivalirudin is dependent on renal function but independent of dose and gender. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. The recommended dose of angiomax is an intravenous bolus dose of 0. All other uses including for surgical proceduresintraoperative use, call anticoagulation service. Angiomax bivalirudin dose, indications, adverse effects. Effient prasugrel dose, indications, adverse effects. Medscape indicationspecific dosing for angiomax bivalirudin, frequency based adverse effects.
Elimination of bivalirudin is through a combination of renal excretion and proteolytic. Evaluation of pretest clinical score 4 ts for the diagnosis of heparininduced thrombocytopenia in two clinical settings. Heparin induced thrombocytopenia hit treatment page 1 of 7. Therapeutic monitoring of warfarin while on bivalirudin. The dosing presented below is a guide to aid in the initiation of bivalirudin infusion. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Bivalirudin does not bind to plasma proteins other than thrombin or to red blood cells. Dosing is adjusted for patients with renal insufficiency, and a quick. Angiomax bivalirudin dosing, indications, interactions, adverse. Approximately 20% of unchanged drug is cleared via the kidney, and the remainder presumably undergoes proteolysis intracellularly. The information on dosage adjustments in renal impairment given in this book is based on. Reduce the bivalirudin infusion dose and monitor anticoagulant status more frequently in patients with a crcl less than 30 mlminute. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal.
Weightbased bivalirudin protocol for heparin induced. Patients with renal dysfunction patients with severe hypertension patients with a baseline aptt ratio 1. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal impairment. In patients with normal renal function, the plasma halflife is 25 minutes, whereas in hemodialysis patients it is 3. Angiomax is supplied as a sterile white lyophilized cake, in singledose vials. Bivalirudin is a generic medicine name and there are several brands available for it. Dailymed bivalirudin injection, powder, lyophilized, for. Bivalirudin has a halflife of approximately 25 minutes and a response that is linearly proportional to its dosing, with coagulation parameters returning to baseline approximately 1 to 2 hours after its discontinuation in patients with normal renal function. Some of the brands for bivalirudin might be better known than bivalirudin itself. No reduction in the bolus dose is needed for any degree of renal impairment. We aimed at evaluating its safety and its optimal dosing for ecmo. Bivalirudin see appendix a for dosing heparin induced thrombocytopenia hit treatment page 1 of 7. Dosing is adjusted for patients with renal insufficiency, and a quick reference table is provided below using a standard concentration of 250 mg100 ml. Pathology consultation on monitoring direct thrombin inhibitors.
Uconn health john dempsey hospital 1 bivalirudin angiomax dosing table bivalirudin is a direct thrombin inhibitor, and it is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention pci. Bivalirudin initial dosing anticoagulation services. Bivalirudin should be administered with optimal antiplatelet therapy aspirin plus clopidogrel. An unexplained fall in blood pressure or hematocrit, or any unexplained symptom, should lead to serious consideration of a hemorrhagic. The recommended dose of bivalirudin for injection is an intravenous bolus dose of 0. Pdr drug summaries are concise pointofcare prescribing, dosing and administering information to help phsyicans more efficiently and accurately prescribe in their practice pdr s drug summaries are available free of charge and serve as a great resource for us based mds, dos, nps and pas in patient practice. Dose reduction is warranted in renal insufficiency table 100. Bivalirudin is fda approved for use in patients with unstable angina undergoing pci with or. At the time our hospitals bivalirudin dosing protocol was created and implemented there was limited data available for dosing bivalirudin in ecmo patients and it was felt that more conservative dose adjustments where the actual change was less than the predicted was preferable so we were not overanticoagulating our patients.
Bivalirudin for treating heparin induced thrombocytopenia. The offlabel dose of bivalirudin for managing hit is suggested as 0. When treating hit, bivalirudin should be continued until the platelet count normalizes. Bivalirudin is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage, with a halflife in patients with normal renal function of 25 min. In adults with normal renal function, bivalirudin has a clearance of. The renal drug handbook the st georges hospital, adult critical.
Bivalirudin is renally cleared, in addition to proteolytic cleavage in the blood. It is not intended as medical advice for individual conditions or treatment. No reduction required for any degree of renal impairment. Patients with renal impairment should be carefully. Bivalirudin is cleared by a combination of renal elimination and intravascular proteolysis, with renal elimination thought to be the major route of clearance. Safety and efficacy have not been established in patients younger than 18 years. Bivalirudin for injection has been studied only in patients receiving concomitant aspirin. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Bivalirudin 832 din in severe renal dysfunction is prolonged to about 1 h, and in the setting of dialysisdependent renal failure, the halflife approaches 4 h. The information contained in the truven health micromedex products as delivered by goodrx is intended as an educational aid only. Initial dosing in patients with renal dysfunction, including those on hemodialysis, is unclear.
1020 629 663 714 1577 659 717 352 1038 1261 1101 1429 552 518 1180 646 98 19 961 1482 329 1598 1009 517 210 279 1432 808 5 865 932 291 698 923 672 846