Bivalirudin
Also known as: Angiomax, Angiox
Bivalirudin is a bivalent direct thrombin inhibitor that reversibly binds both the catalytic active site and the anion-binding exosite of circulating and clot-bound thrombin to block fibrin formation.
This page is a structured profile. Narrative evidence, dosing context and FAQs live on the research guide — not duplicated here as a second full article.
- Drug class
- Direct thrombin inhibitor (parenteral anticoagulant; hirudin-derived peptide)
- Primary targets
- Thrombin (active catalytic site), Thrombin anion-binding exosite (exosite 1)
- Dose reference
- Per the Angiomax FDA label (not a recommendation): IV bolus 0.75 mg/kg followed by 1.75 mg/kg/h infusion for the duration of PCI, with a 0.3 mg/kg supplemental bolus if needed and infusion reduced in renal impairment/dialysis.
- Half-life
- About 25 minutes with normal renal function; roughly 34-57 minutes in renal impairment and about 3.5 hours in dialysis-dependent patients (Angiomax label).
- Developer / origin
- The Medicines Company (originally developed as Hirulog/bivalirudin)
- Reference year
- 2000
- Evidence score
- 4/5 - Approved with supportive randomized trial evidence
Approved uses
- Anticoagulant for patients undergoing percutaneous coronary intervention (PCI)
- Patients with, or at risk of, heparin-induced thrombocytopenia and thrombosis syndrome (HIT/HITTS) undergoing PCI
Approved with supportive randomized trial evidence
Bivalirudin is FDA-approved as a procedural anticoagulant for PCI, supported by large randomized trials (BAT, HORIZONS-AMI and later PCI studies) and a detailed prescribing label; its benefit is comparator-dependent and it carries a documented acute stent thrombosis signal in STEMI.
Investigational compound with human randomized or phase 2/3 evidence.
Evidence basis
- FDA-approved Angiomax prescribing information defines indication, dosing, mechanism, pharmacokinetics and warnings
- BAT trial (>4,000 patients) compared bivalirudin to heparin during angioplasty for unstable/postinfarction angina
- HORIZONS-AMI and subsequent PCI trials evaluated bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors
- Pharmacology reviews characterize the bivalent, reversible direct thrombin inhibition mechanism
Key references
- DailyMedAngiomax (bivalirudin) prescribing information
- PubMedTreatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina (BAT trial)
- PubMedBivalirudin during primary PCI in acute myocardial infarction (HORIZONS-AMI)
- PubMedBivalent direct thrombin inhibitors: hirudin and bivalirudin
How to read this entry
Dose references and half-life values are pulled from trial protocols, labels, reviews, or published summaries where available. They are context for research and comparison, not a personal dosing recommendation.
Status matters: approved drugs have regulated indications; investigational compounds are still being studied; research-only peptides do not have established human dosing, safety, or efficacy for consumer use.
Bivalirudin guides
Read the matching guide or adjacent research pages for more context.
Peptide calculators
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