Anticoagulation, endocrine and GI
Bivalirudin (Angiomax) drip
Angiomax
Dosing
| Start | HIT: 0.15 mg/kg/h, lower in kidney failure (no bolus). PCI: 0.75 mg/kg bolus, then 1.75 mg/kg/h |
|---|---|
| Titrate | To aPTT 1.5–2.5 times baseline per protocol |
| Maximum | Per protocol |
| Common bags | 250 mg in 250 mL (1 mg/mL); 250 mg in 500 mL (500 mcg/mL) |
| Dose units | mg/kg/h |
Line and administration
- Dedicated line or compatible Y-site
Watch for
- Partly cleared by the kidneys: reduce in kidney failure
- Short half-life (about 25 minutes)
- Bleeding; no reversal agent
Bivalirudin: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Bleeding, Reversal, HIT and DICHeparin-induced thrombocytopenia (HIT): Start a non-heparin anticoagulant at once: argatroban (liver-cleared; good in kidney failure) or bivalirudin; fondaparinux or a DOAC when stable
- ACS and STEMIInitial medications: Heparin (UFH): PCI: 70-100 units/kg to ACT; lytic: 60 units/kg (max 4,000): Or bivalirudin, enoxaparin
- ECMO EssentialsMonitoring and anticoagulation: UFH is usual; bivalirudin or argatroban if HIT. High free Hb, bilirubin or lipids falsely lower anti-Xa. Follow your institution's protocols.
- LVAD BasicsComplications: Pump thrombosis: Rising power, high LDH and free Hgb, dark urine: IV heparin or bivalirudin; pump exchange if refractory
- Impella Heart PumpPurge system: HIT: stop all heparin, purge included. Use a bicarbonate-dextrose purge and IV argatroban or bivalirudin, per your institution's or agency's protocols.
Practice Bleeding, Reversal, HIT and DIC questions free34 exam-style questions with rationales on the topic where bivalirudin comes up most. No account or download needed.
Other anticoagulation, endocrine and gi
- Heparin
- Insulin (regular)
- Amiodarone
- Diltiazem
- Octreotide
- Pantoprazole
- Furosemide
- Argatroban
- Procainamide
- Lidocaine
- Magnesium sulfate
- Naloxone
- Eptifibatide
- Bumetanide
Practice free in your browser3,800+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.