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Cardiovascular & blood

Bivalirudin

Also called Angiomax, Hirulog, Bivalirudin trifluoroacetate

Bivalirudin is a lab-made blood thinner based on hirudin, the anticoagulant found in leech saliva. It is given by IV during heart artery procedures (PCI), including in people who cannot use heparin.

FDA-approvedApproved by the FDA for at least one use after large human trials.

All printable flashcards

Drawn from its published sequence: 20 residues, one bead each.

Overview

Bivalirudin is a lab-made blood thinner based on hirudin, the anticoagulant found in leech saliva. It is given by IV during heart artery procedures (PCI), including in people who cannot use heparin.

How it works

Established: bivalirudin directly blocks thrombin, the key clotting enzyme, by binding both its active site and its substrate-recognition site (exosite 1). It works on free and clot-bound thrombin. Thrombin slowly cuts bivalirudin apart, so the block is reversible and short-lived (half-life about 25 minutes with normal kidneys) (FDA label).

What research shows

  • BAT trials (4,312 patients with unstable angina undergoing angioplasty): composite ischemic endpoint 7.9% vs 9.3% with heparin; major bleeding 3.7% with bivalirudin (FDA label).
  • AT-BAT (51 patients with HIT/HITTS, single-arm): no major bleeding reported (FDA label).

Doses studied in people

Study or labelDose usedSource
FDA label, anticoagulation during PCI0.75 mg/kg IV bolus, then 1.75 mg/kg/h infusion for the procedure; infusion reduced to 1 mg/kg/h if CrCl <30 mL/min and 0.25 mg/kg/h on hemodialysis1

Hospital-only IV drug; dose is weight-based and adjusted for kidney function per the label.

Read this first: these are the amounts given to participants in published studies or written on official prescribing labels, reported for reference. They are not recommendations. Trial doses were chosen for specific patients under medical supervision, and a dose that is safe in one person can be harmful in another.

Safety

  • Bleeding, the most common adverse reaction (3.7% in BAT trials), including intracranial and retroperitoneal bleeding (FDA label).
  • Thrombus formation, including fatal cases, with gamma brachytherapy (FDA label).
  • Postmarketing: fatal bleeding, hypersensitivity/anaphylaxis, cardiac tamponade, pulmonary hemorrhage (FDA label).

Report side effects of any drug or product to the FDA through MedWatch. For a possible poisoning in the US, call Poison Control at 1-800-222-1222.

Storage and stability

Unopened vials at 20-25°C; do not freeze reconstituted or diluted solutions (FDA label).

General lab handling, not instructions for personal use. See Storage and stability.

History

Bivalirudin (originally called Hirulog) was designed in the early 1990s as a smaller, synthetic version of leech hirudin. The FDA first approved it as Angiomax in 2000 as an anticoagulant for angioplasty/PCI, and later for PCI in patients with heparin-induced thrombocytopenia (HIT).

Common questions

Is bivalirudin FDA-approved?

Yes. It was approved as Angiomax in 2000 and generics are available, as a blood thinner during heart artery procedures (PCI), including in people with heparin-induced low platelets (HIT) 12. It is used in hospitals only 1.

How does bivalirudin work?

It directly blocks thrombin, the main clotting enzyme, including thrombin already inside a clot 1. Thrombin slowly breaks it down, so the effect is short, with a half-life of about 25 minutes when the kidneys work normally 1.

What did the main trials find?

In the BAT trials of 4,312 patients having angioplasty, serious heart-related events occurred in 7.9% versus 9.3% with heparin 12. In a small study of 51 patients with HIT, no major bleeding was reported 12.

What dose is on the FDA label?

The label lists a 0.75 mg/kg IV bolus followed by a 1.75 mg/kg per hour infusion during the procedure, lowered for poor kidney function or dialysis 1. It is a weight-based hospital dose set by the care team, not a general dose 1.

What are the main risks?

Bleeding is the most common side effect, seen in 3.7% of patients in the BAT trials, and it can be serious, including bleeding in the brain 1. The label also lists clot formation during a type of radiation treatment called gamma brachytherapy, and severe allergic reactions 1.

Is bivalirudin banned in sport?

It is not named on WADA's 2026 Prohibited List 90.

Related compounds

Cardiovascular & bloodFDA-approvedFlashcard

Eptifibatide

Integrilin

Eptifibatide is a small ring-shaped peptide, modeled on a rattlesnake venom protein, that stops platelets from clumping.

Sources

  1. Bivalirudin injection prescribing information FDA label
  2. Angiomax (bivalirudin) prescribing information FDA label
  3. KEGG DRUG: Bivalirudin (D03136) Journal
  4. WADA 2026 Prohibited List Regulatory

Last reviewed 2026-10-25 · How we research · Found an error? See our corrections policy.