Bivalirudin

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

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-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.
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