A number of the reported overdoses were due to failure to adjust the infusion dose of bivalirudin in persons with renal dysfunction including persons on hemodialysis. As of today we have 110,518,197 ebooks for you to download for free. Detailed drug guide including the drug terms, brands and generics. Each patient received a bolus dose of bivalirudin 1 mgkg followed by an infusion 2. Bivalirudin wisconsin alzheimers disease research center. Bivalirudin, heparin comparable after pci with renal. Bivalirudin during primary pci in acute myocardial infarction pdf. Bivalirudin dosing adjustments for reduced renal function with or without hemodialysis in the management of heparininduced thrombocytopenia. Find patient medical information for bivalirudin in 0. Heparin induced thrombocytopenia hit treatment page 1 of 7. Weightbased bivalirudin protocol for heparin induced. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or severe renal impairment.
Jan 09, 2020 renal dose adjustmentsno reduction in the bolus dose is recommended for any degree of renal impairmentcrcl less than 30 mlmin. If a patient is on hemodialysis, the infusion should be reduced to 0. The clearance of bivalirudin is dependent on renal function but independent of dose and gender. No annoying ads, no download limits, enjoy it and dont forget to bookmark and share the love. The molecular formula of bivalirudin free base is c 98 h 8 n 24 o 33 and its molecular weight is 2180. Reduce the bivalirudin infusion dose and monitor anticoagulant status more frequently in patients with a crcl less than 30 mlminute. For seizure indication, administer q12h but may require. 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. Evaluation of bivalirudin treatment for heparininduced. The recommended dose of bivalirudin is an intravenous bolus dose of 0.
The binding of angiomax to thrombin is reversible as thrombin slowly cleaves the angiomaxarg3pro4 bond, resulting in recovery of thrombin active site functions. The use of bivalirudin in patients with renal impairment. Odds ratio plot for bivalirudin versus heparin by renal function quadruple end point. You will receive this injection during your angioplasty procedure in a clinic or hospital setting. Highlights of prescribing information for patients. The infusion dose of angiomax may need to be reduced, and anticoagulant status monitored in patients with renal impairment. Please use the following for the initial dose of bivalirudin in heparininduced thrombocytopenia hit. Doses may require adjustment in patients with renal impairment, but no specific dosing guidelines are available for this population.
The editorial members are also part of the uk renal pharmacy group as well as active renal practitioners. Compounds such as lepirudin and desirudin are recombinant hirudin derivatives that directly inhibit free and fibrinbound thrombin and block its activity. Bivalirudin dosing adjustments for reduced renal function. If the dose is changed, check the aptt in 4 hours after the infusion change is made. Bivalirudin for injection is supplied as a sterile white lyophilized cake, in single dose vials. Do not freeze reconstituted or diluted bivalirudin. Bivalirudin initial dosing anticoagulation services. Jun 17, 2002 the clearance of bivalirudin is dependent on renal function but independent of dose and gender. An unexplained fall in blood pressure or hematocrit, or any unexplained symptom, should lead to serious consideration of a hemorrhagic. Printed on acid free paper international standard book number. Dailymed bivalirudin injection, powder, lyophilized, for. Anticoagulation with bivalirudin during cardiopulmonary. For oncedaily dosing, draw a single random level 8 to 12 hours after dose given adjustments are made based on a published hartford nomogram.
Drug dictionary is a medical hand book that provides all information about drugs used for medication. Bivalirudin provides increasing benefit with decreasing renal. Eighteen patients older than 18 years who were admitted to the. Angiomax bivalirudin dose, indications, adverse effects. Normal dose based on indication, titrate according to target serum level. Bivalirudin reversibly binds thrombin, free as well as clot bound, at the catalytic site and the anionbinding exosite, thereby preventing the formation and activation of fibrin, factor xiiia, and other coagulation factors. Bivalirudin should be administered with optimal antiplatelet therapy aspirin plus clopidogrel. Following the withdrawal of lepirudin in 2012 we needed to establish inhouse therapeutic ranges and dosing schedules for both dti. Find patient medical information for bivalirudin intravenous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Jun 28, 2019 bivalirudin does not bind to plasma proteins other than thrombin or to red blood cells. An interaction between the degree of renal impairment and the overall benefit from bivalirudin was observed on an additive scale p 0. Bivalirudin does not bind to plasma proteins other than thrombin or to red blood cells.
Crrt indicates continuous renal replacement therapy. 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. The disposition of bivalirudin was studied in ptca patients with mild and moderate renal function and in patients with severe renal function. The recommended dose of angiomax is an intravenous bolus dose of 0. Adverse drug reactions are to be documented and reported to a medical officer. Adjunct bivalirudin dosing protocol for neuroendovascular procedures article pdf available in journal of vascular and interventional neurology 12. Safety and efficacy have not been established in patients younger than 18 years. Bivalirudin has a halflife of 25 minutes in ptca patients with normal renal function. Tell your doctor if you are pregnant before you are treated with bivalirudin and aspirin. Correlation between dose and crrt replacement fluid rate.
The infusion dose of bivalirudin may need to be reduced, and anticoagulant status monitored in patients with renal impairment. To evaluate the safety, effectiveness, and dosing of bivalirudin for treatment of heparininduced thrombocytopenia hit in critically ill patients with hepatic andor renal dysfunction. In in vitro studies, angiomax inhibited both soluble free and clotbound. Dosing is adjusted for patients with renal insufficiency, and a quick reference table is provided below using a standard concentration of 250 mg100 ml. Effect of direct thrombin inhibitors, bivalirudin, lepirudin, and argatroban, on prothrombin time and inr values. Angiomax bivalirudin dosing, indications, interactions. Each vial contains 250 mg bivalirudin, equivalent to an average of 270 mg of bivalirudin trifluoroactetate, 125 mg mannitol, and sodium hydroxide to adjust the ph to 5 to 6 equivalent of approximately 12. Bivalirudin, heparin comparable after pci with renal impairment. 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. The molecular weight of bivalirudin is 2180 daltons anhydrous free base peptide.
General renal dosing guidelines agents not listed below click here for a specialized list of other renal medication dosing not listed in the alphabetical main section simple renal dosing guidelines. The scottish medicines consortium has advised december 2008 that bivalirudin angiox is accepted for restricted use within nhs scotland for adults with acute coronary syndromes planned for urgent or early intervention who would have been considered for treatment with unfractionated heparin in combination with a glycoprotein iibiiia inhibitor. Its short halflife and predominantly extrarenal elimination are reasons why it is. Renal dose adjustmentsno reduction in the bolus dose is recommended for any degree of renal impairmentcrcl less than 30 mlmin. Although experience has been gathered in the use bivalirudin during cardiac surgery with and without cpb, no dosing regimen for anticoagulation of a completely closed ecmo system exists. Evaluation of the use of argatroban or bivalirudin for the. Nephrology and transplantation, royal free hospital. The study protocol used the previously described bivalirudin dosing to include an initial bolus of 0. Patients with moderate renal impairment 3059 mlmin should receive an infusion of 1. In in vitro studies, bivalirudin inhibited both soluble free and clotbound thrombin, was not neutralized by products of the platelet release reaction, and prolonged the activated partial. An unwanted blood clot can occur with certain heart or blood vessel conditions. The clearance of bivalirudin was reduced approximately 20% in patients with moderate and severe renal impairment and was reduced approximately 80% in dialysisdependent patients. Safety, efficacy and dosing requirements of bivalirudin patients with heparininduced thrombocytopenia. Bivalirudin side effects, dosage, interactions drugs.
Successful use of bivalirudin as anticoagulant for ecmo in a. Evaluation of pretest clinical score 4 ts for the diagnosis of heparininduced thrombocytopenia in two clinical settings. Anticoagulation with bivalirudin during cardiopulmonary bypass in cardiac surgery. Dosing for bivalirudin and argatroban is substantially different when given for. Dosing is adjusted for patients with renal insufficiency, and a quick. Lo gk, juhl d, warkentin te, sigouin cs, eichler p, greinacher a. Management of refractory bleeding postcardiopulmonary bypass in. Angiomax has been studied only in patients receiving concomitant aspirin. Bivalirudin is not expected to be harmful to an unborn baby. In view of these considerations, the potential need to switch from ecmo to cpb encouraged the decision to use bivalirudin as a treatment option. Nov 09, 2018 bivalirudin is an anticoagulant thrombin inhibitor that helps prevent the formation of blood clots. For this reason, bivalirudin requires dose adjustment in renal impairment table i but not hepatic dysfunction 17. However, aspirin is sometimes given with bivalirudin, and taking aspirin during late pregnancy may cause bleeding in the mother or the baby during delivery. Practical guidelines for argatroban and bivalirudin in.
The idea for such a book grew out from some of the entries in our sister book clinical pharmacy pocket companion, which, as well as covering many clinical topics such as electrolyte disturbances and perioperative management of medicines, also deals with a number of medicines requiring therapeutic monitoring. This third edition of the renal drug handbook is a fantastic publication. Following the withdrawal of lepirudin in 2012 we needed to establish inhouse therapeutic ranges and dosing schedules for both dti, since their practical handling was not clearly defined. Argatroban and bivalirudin are two direct thrombin inhibitors dti employed to treat heparininduced thrombocytopenia hit. Jul 29, 2019 angiomax is supplied as a sterile white lyophilized cake, in singledose vials. Hirudin derivative an overview sciencedirect topics. A catalogue record for this book is available from the british library. No reduction in the bolus dose is needed for any degree of renal impairment. The level of renal function below which the dose of a drug must be. The infusion dose of bivalirudin for injection may need to be reduced, and anticoagulant status monitored in patients with renal impairment. Patients with moderate renal impairment 3059 mlmin should.
Bivalirudin reversibly binds thrombin, free as well as clot bound, at the catalytic site and the anionbinding exosite, thereby preventing the formation and activation of. Bivalirudin has been studied only in patients receiving concomitant aspirin. Patients with moderate renal impairment 30 to 59 mlmin should receive an infusion of 1. Article information, pdf download for management of refractory. In dialysis dependent patients, clearance is reduced by approximately 80%. Angiomax is supplied as a sterile white lyophilized cake, in single dose vials. The use of bivalirudin in pediatric cardiac surgery and in. Approximately 20% of unchanged drug is cleared via the kidney, and the remainder presumably undergoes proteolysis intracellularly. 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. A reduction in the infusion dose of bivalirudin should be considered in patients with moderate or. The total body clearance of bivalirudin in ptca patients with normal renal function is 3. Bivalirudin is cleared from plasma by a combination of proteolytic cleavage 80% and renal mechanisms 20%, therefore, dose needs only to be adjusted in patients with moderate or severe renal.
Reduce bolus injection of bivalirudin full text view. Bivalirudin 250 mg powder for concentrate for solution for. A number of the reported overdoses were due to failure to adjust the infusion dose of bivalirudin in persons with renal dysfunction including persons on hemodialysis see dosage and administration 2. The first comprised 25 patients who were undergoing percutaneous coronary intervention8 with normal renal function, 11 with mild renal impairment, and 6 with moderate renal impairment. Aggrenox aspirinextendedrelease dipyridamole capsules. Renal drug handbook 3rd edition general intensive care unit. Diluted bivalirudin with a concentration between 0.
Of the 18 patients identified, 12 had both hepatic and renal dysfunction group 1, four had hepatic dysfunction group 2, and two had renal. Bivalirudin is contraindicated in patients with severe renal insufficiency gfr renal insufficiency, the acs dose 0. Renal clearance of bivalirudin is decreased in patients with moderate to severe renal impairment or dialysisdependent renal failure. Bivalirudin is a 20 amino acid long synthetic peptide with thrombinspecific anticoagulant properties. In patients with moderate gfr 30 to 59 mlminute and severe gfr 10 to 29 mlminute renal impairment, plasma clearance of bivalirudin is reduced by approximately 20%. Welcome to the fifth edition of the renal drug handbook. Bleeding, as well as deaths due to hemorrhage, have been observed in some reports of overdose. The clearance of bivalirudin is reduced by approximately 20% in adults with moderate to severe renal impairment and by 80% in patients with end stage renal disease. For hd, draw trough prehd, and peak 30 min after end of each infusion streptococci, streptococcus bovis, strep. The renal drug handbook 5th edition medicina interna. Patients with moderate renal impairment 3059 mlmin should receive an infusion of.
Bivalirudin 95 bleomycin 96 bortezomib 97 bosentan 98 bromocriptine 99 budesonide 100 bumetanide 101. The renal drug handbook the st georges hospital, adult critical. Therapeutic monitoring of warfarin while on bivalirudin. General renal dosing for healthcare professionals guidelines. 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 minutes. Compounds such as lepirudin and desirudin are recombinant hirudin derivatives that directly inhibit free and.
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