[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Parenteral direct thrombin inhibitors](https://durgical.com/en/pharmacology/classes/parenteral-direct-thrombin-inhibitors/) › Bivalirudin [Pharmacology](https://durgical.com/en/pharmacology/) · [Parenteral direct thrombin inhibitors](https://durgical.com/en/pharmacology/classes/parenteral-direct-thrombin-inhibitors/) # Bivalirudin An intravenous peptide that blocks thrombin directly during coronary angioplasty. Its effect fades about an hour after the infusion stops. Updated 2026-11-01 - Class: [Parenteral direct thrombin inhibitors](https://durgical.com/en/pharmacology/classes/parenteral-direct-thrombin-inhibitors/) - Enzyme: Thrombin (coagulation factor IIa) - ATC code: B01AE06 ## ⚠ High-alert medication An error with this medicine can cause serious harm: double checks and protocols are used. ✂**Thrombin (coagulation factor IIa)**Bivalirudin ⓘ The figure shows human thrombin with bivalirudin; bivalirudin is a peptide chain in the crystal, so no small-molecule ligand is marked. **Target in 3D:** Thrombin (coagulation factor IIa). PDB structure 3VXE (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3VXE) · Drag to rotate · pinch to zoom ## Mechanism of action Bivalirudin is a synthetic 20-amino-acid peptide. One end fits the active site of thrombin and the other end the anion-binding exosite where fibrinogen docks, so it blocks free and clot-bound thrombin. The block is reversible: thrombin slowly cuts the peptide and recovers its activity. - Bivalirudin binds thrombin's active site and its fibrinogen exosite - Free and clot-bound thrombin are blocked without antithrombin - Thrombin slowly cleaves it, so the block wears off ## Pharmacokinetics **Metabolism** Broken down by proteolytic cleavage. **Elimination** Kidneys and proteolysis; clearance falls in moderate or severe kidney impairment and much more in dialysis patients. It is partly removed by haemodialysis. **Half-life** About 25 minutes with normal kidney function; longer in kidney impairment. **Onset and duration** Immediate by vein; coagulation times return to baseline about 1 hour after stopping. ## Indications - Anticoagulation during percutaneous coronary intervention, including in patients with heparin-induced thrombocytopenia. [Heparin-induced thrombocytopenia →](https://durgical.com/en/conditions/heparin-induced-thrombocytopenia/) - PCI in acute myocardial infarction, including STEMI. [Myocardial Infarction (Heart Attack) →](https://durgical.com/en/conditions/myocardial-infarction/) ## Adverse effects ### Common - Bleeding, the most common reaction ### Serious (rare, important) - Major and sometimes fatal bleeding - Hypersensitivity reactions, including anaphylaxis - Acute stent thrombosis in STEMI patients undergoing primary PCI - Thrombus formation, sometimes fatal, during coronary gamma brachytherapy ## Contraindications - Active major bleeding - Hypersensitivity to bivalirudin ## Key interactions **Heparin, warfarin, thrombolytics or glycoprotein IIb/IIIa inhibitors** Increase the risk of major bleeding. ## What is monitored - Activated clotting time (ACT) during the procedure - Kidney function, which sets the infusion regimen - Access site, haemoglobin and signs of bleeding after the procedure ## Administration and safety - Intravenous bolus followed by continuous infusion, after reconstitution and dilution of the powder - The reconstituted solution is clear to slightly opalescent and is not frozen - The infusion is reduced in kidney impairment; overdoses have happened when this was missed, including in haemodialysis - No specific antidote; its short half-life is the main safety margin ## Nursing care - Check kidney function and weight before the procedure - Watch the arterial access site, haemoglobin and blood pressure after PCI - Report chest pain after a STEMI procedure: possible acute stent thrombosis - Record the ACT values and infusion changes ## Pregnancy and breastfeeding There are no human data in pregnancy; it is used only when the benefit justifies the risk. ## Memory aid BIvalirudin BItes twice: the active site and the exosite, and lets go within an hour. ## Test yourself Think of the answer, then tap the question to see it. ## Which two sites of thrombin does bivalirudin bind? The catalytic (active) site and the anion-binding exosite where fibrinogen docks. ## How is bivalirudin followed during PCI? With the activated clotting time (ACT). ## Why must the bivalirudin infusion be adjusted in kidney impairment? It is partly cleared by the kidneys; its clearance falls and its half-life lengthens, and overdoses have occurred when the infusion was not reduced. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/bivalirudin/) ## Related drugs - [Argatroban](https://durgical.com/en/pharmacology/argatroban/) - [Heparin](https://durgical.com/en/pharmacology/heparin/) - [Dabigatran](https://durgical.com/en/pharmacology/dabigatran/) - [Clopidogrel](https://durgical.com/en/pharmacology/clopidogrel/) ## Related conditions - [Heparin-induced thrombocytopenia](https://durgical.com/en/conditions/heparin-induced-thrombocytopenia/) - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) [← Back to the class: Parenteral direct thrombin inhibitors](https://durgical.com/en/pharmacology/classes/parenteral-direct-thrombin-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - BIVALIRUDIN injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ce56f806-7845-429d-a1ce-c2dbf79b22eb) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=B01AE&showdescription=no) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [3VXE: Human alpha-thrombin-Bivalirudin complex at PD5.0](https://www.rcsb.org/structure/3VXE) (RCSB Protein Data Bank, 2013). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/bivalirudin/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/bivalirudin/