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Bivalirudin - Angiomax ® - Renal dosing

Usual Dosing (Adults)

Dosing and Administration

For patients who do not have HIT/HITTS

  • PCI/PTCA: 0.75 mg/kg intravenous (IV) bolus dose followed by a 1.75 mg/kg/h IV infusion for the duration of the procedure.
  • Perform activated clotting time (ACT) test 5 minutes post-bolus dose. If needed, give an additional bolus of 0.3 mg/kg.
  • After PCI/PTCA, IV infusion may be continued for up to 4 hours, after which a rate of 0.2 mg/kg/h can be used for up to 20 more hours, if needed.
  • Consider glycoprotein IIb/IIIa inhibitor (GPI) administration with procedural complications.

For patients who have HIT/HITTS

  • The recommended dose of Angiomax in patients with HIT/HITTS undergoing PCI is an IV bolus of 0.75 mg/kg. This should be followed by an infusion at a rate of 1.75 mg/kg/h for the duration of the procedure.
  • After PCI/PTCA, IV infusion may be continued for up to 4 hours, after which a rate of 0.2 mg/kg/h can be used for up to 20 more hours, if needed.

For patients with Renal Impairment

  • No reduction in bolus dose required. Consider reduction of the rate of infusion to 1 mg/kg/hour for CrCL <30 mL/min or 0.25 mg/kg/hour if on dialysis.

Renal Dosing

dialysis Initial bolus dose remains unchanged. Monitor activated coagulation time (ACT).
[> 30 ml/min]: No adjustment required
[10-29 ml/min]: Decrease infusion rate to 1 mg/kg/hour.

Hemodialysis

dialysis Dialysis-dependent patients (off dialysis): Decrease infusion rate to 0.25 mg/kg/hour. No reduction in the bolus dose is needed.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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