Bivalirudin (Angiomax)
Overview
A synthetic 20-amino acid peptide that acts as a direct thrombin inhibitor by binding both the catalytic active site and anion-binding exosite 1 of thrombin. Bivalirudin inhibits both free and clot-bound thrombin, providing more predictable anticoagulation than heparin without requiring antithrombin III as a cofactor. It is enzymatically cleaved by thrombin itself, producing a self-limiting anticoagulant effect with a 25-minute half-life.
Key Research Findings
FDA-approved for use in percutaneous coronary intervention (PCI) and as an anticoagulant in patients with or at risk of heparin-induced thrombocytopenia (HIT). HORIZONS-AMI trial showed reduced major bleeding and 30-day mortality vs. heparin plus GP IIb/IIIa inhibitors in primary PCI for STEMI. Does not cause immune-mediated thrombocytopenia. Widely used as an alternative to heparin in the cardiac catheterization lab.
Intravenous
FDA Approved
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