Bivalirudin
Aliases: Angiomax
Last verified: 2026-09-23
The short version
A 20-aa peptide — direct thrombin inhibitor (hirudin analogue), anticoagulant in PCI.
Identity & type
- Molecular type
- analog
- Origin
- A 20-aa peptide — direct thrombin inhibitor (hirudin analogue), anticoagulant in PCI.
Mechanism of action
Bivalently binds thrombin (catalytic site + exosite 1), reversibly.
Dosing & routes
Official / clinical context
Approved drug — indications, dosing and warnings are defined by the official label. IV bolus 0.75 mg/kg + 1.75 mg/kg/h during PCI.
Regulator-approved labeling and published study designs — never a recommendation.
Community-reported practice
IV bolus 0.75 mg/kg + 1.75 mg/kg/h during PCI. Angiomax: an anticoagulant during PCI with lower bleeding risk than heparin; hospital use.
Unverified self-reports. Not medical advice. Not endorsement.
Expected effects (community)
Angiomax: an anticoagulant during PCI with lower bleeding risk than heparin; hospital use.
Protocol — official vs community
Official / label
Angiomax (PCI anticoagulation): 0.75 mg/kg IV bolus followed by 1.75 mg/kg/h infusion during the procedure; post-PCI continuation at 1.75 mg/kg/h for up to 4 h is label-supported in STEMI, with optional reduced-rate infusion beyond.
Duration: Hours — procedure-scoped. Dose-adjust per label in renal impairment; the short half-life (~25 min) makes it effectively self-reversing.
HORIZONS-AMI established its bleeding advantage over heparin plus GP IIb/IIIa in primary PCI. Hospital-only agent; there is no outpatient or community context for a drug whose half-life is measured in minutes.
Community (anecdotal)
Structured protocol data for this entry is coming.
Human evidence
HORIZONS-AMI and later PCI trials.
Preclinical evidence
The preclinical phase was completed and submitted to regulators as part of registration; pharmacology and toxicology details are part of the official label.
Known risks
- Bleeding (less than heparin+GPI).characterized
Teal: characterized in clinical/labeling contexts. Amber: theoretical or reported outside controlled settings.
Unknowns & evidence gaps
- Real-world data outside controlled trials