A drip anticoagulant used during heart procedures
Bivalirudin
A hospital drip anticoagulant used during heart procedures such as angioplasty and stenting.
What is Bivalirudin?
Bivalirudin is an anticoagulant (a clot-preventing medicine) given by drip into a vein in hospital, mainly during heart procedures such as percutaneous coronary intervention (PCI) — angioplasty and stenting to open blocked heart arteries. It is a direct thrombin inhibitor, blocking thrombin, a key protein in clotting, so that harmful clots do not form during the procedure. The main risk is bleeding, so it is given with monitoring in a hospital setting. It acts quickly and wears off fairly soon after the drip is stopped. It is used only in hospital under specialist supervision.
Education and reference only. This is a plain-language guide to Bivalirudin — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Bivalirudin is an anticoagulant given as a drip into a vein, used mainly in the cardiac catheter laboratory during heart procedures such as percutaneous coronary intervention (PCI), which includes balloon angioplasty and the placing of stents to open narrowed or blocked heart arteries. It belongs to a group called direct thrombin inhibitors. It is used to stop clots forming on the equipment and in the artery during the procedure. Because it is a powerful blood-thinner that needs careful handling, it is given only in hospital, by specialist heart teams, with monitoring.
How it works
Clotting ends in the action of thrombin, a protein that builds the mesh of a blood clot. Bivalirudin directly blocks thrombin, preventing clots from forming on the wires, balloons and stents used during a heart procedure and within the treated artery. It works quickly when started and, helpfully, its effect fades fairly soon after the drip is stopped, which suits the timing of procedures. The same clot-blocking action that makes it useful is also the reason its main risk is bleeding, especially around the site where the catheter is inserted.
Company & origin
Originated / developed by: Specialist manufacturer.
A hospital anticoagulant given by drip into a vein during heart procedures such as angioplasty and stenting.
Practical use
How to take Bivalirudin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by drip into a vein in hospital by the heart team during the procedure, not taken at home.
- Tell the team straight away about any bleeding, including from the catheter site, or any new bruising.
- Let the team know about any kidney problems, as the amount given may need to be adjusted.
- Mention any history of heparin-induced thrombocytopenia, as bivalirudin may be chosen as an alternative.
- Follow the team's instructions about rest and care of the catheter site afterwards to reduce bleeding risk.
Weighing it up
Advantages & disadvantages of Bivalirudin
Advantages
- An effective anticoagulant for use during heart procedures such as angioplasty and stenting.
- Acts quickly and its effect fades fairly soon after the drip is stopped.
- Can be used as an alternative to heparin, including in people who have had heparin-induced thrombocytopenia.
Disadvantages
- Its main risk is bleeding, especially around the catheter site.
- Must be given by drip in hospital with monitoring.
- May need dose adjustment in people with kidney problems.
Practical use
Good to know
The key things to understand about bivalirudin are that it is a hospital-only blood-thinner used during heart procedures and that its main risk is bleeding. It is given by drip during the procedure, and the team monitors closely for bleeding, particularly at the site where the catheter is inserted into the artery. A useful feature is that its effect wears off fairly quickly after the drip is stopped, which helps the team manage bleeding risk around the procedure. It is partly cleared by the kidneys, so the amount given may be adjusted in people with kidney problems. It is sometimes chosen as an alternative to heparin, including in people who have had heparin-induced thrombocytopenia. It is always given under specialist heart-team supervision, never at home.
Who should not take it / use with caution
- People who have had a serious allergic reaction to bivalirudin should not be given it.
- It is not used in people with active major bleeding.
- It is used with caution, and dose adjustment, in people with kidney problems, as it is partly cleared by the kidneys.
- It is given only in hospital under specialist heart-team supervision.
Monitoring
- Watching closely for bleeding during and after the procedure, especially at the catheter site.
- Checking kidney function and adjusting the amount given where needed.
- Reviewing blood pressure and overall recovery after the procedure.
Side effects
- Bleeding or bruising, particularly around the catheter site.
- A drop in blood pressure, nausea or headache in some people.
- Rarely, more serious bleeding, which needs urgent medical attention.
Key interactions
- Other blood-thinning or anti-clotting medicines, including antiplatelets, add to the risk of bleeding.
- The team reviews all medicines that affect bleeding before the procedure.
- Always give your full medicines list so the team can plan treatment safely.
Available as: A solution given by drip into a vein in hospital.
Answers
Bivalirudin: frequently asked questions
What is bivalirudin used for?
It is a hospital anticoagulant given by drip during heart procedures such as angioplasty and stenting, to stop clots forming during the procedure.
How is it given?
It is given as a drip into a vein in hospital by the heart team during the procedure, with close monitoring.
What is its main risk?
The main risk is bleeding, particularly around the site where the catheter is inserted, so the team watches for this carefully.
Does it wear off quickly?
Yes, its effect fades fairly soon after the drip is stopped, which helps the team manage bleeding risk around the procedure.
Why might the dose change with kidney problems?
Bivalirudin is partly cleared by the kidneys, so the amount given may be adjusted in people whose kidneys are not working well.
Authoritative sources
- BNF
- NICE CKS
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