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Trade names | Angiomax, Angiox, others |
Other names | d-Phenylalanyl-l-prolyl-l-arginyl -l-prolylglycylglycylglycylglycyl-l-asparaginylglycyl -l-alpha-aspartyl-l-phenylalanyl -l-alpha-glutamyl-l-alpha-glutamyl-l-isoleucyl -l-prolyl-l-alpha-glutamyl-l-alpha-glutamyl -l-tyrosyl-l-leucine |
AHFS/Drugs.com | Monograph |
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Routes of administration | Intravenous injection/infusion only |
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Bioavailability | N/A (IV application only) |
Metabolism | Angiomax is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage |
Elimination half-life | ~25 minutes in patients with normal renal function |
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Chemical and physical data | |
Formula | C98H138N24O33 |
Molar mass | 2180.317 g·mol−1 |
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Bivalirudin, sold under the brand names Angiomax and Angiox, among others, is a specific and reversible direct thrombin inhibitor (DTI).[2] Chemically, it is a synthetic congener of the naturally occurring drug hirudin, found in the saliva of the medicinal leech Hirudo medicinalis. It is manufactured by The Medicines Company.[5]
Bivalirudin lacks many of the limitations seen with indirect thrombin inhibitors, such as heparin. A short, synthetic peptide, it is a potent and highly specific inhibitor of thrombin[2][6][7] that inhibits both circulating and clot-bound thrombin,[7] while also inhibiting thrombin-mediated platelet activation and aggregation.[8] Bivalirudin has a quick onset of action and a short half-life.[2] It does not bind to plasma proteins (other than thrombin) or to red blood cells. Therefore, it has a predictable antithrombotic response. There is no risk for heparin-induced thrombocytopenia or heparin-induced thrombosis-thrombocytopenia syndrome.[2] It does not require a binding cofactor such as antithrombin and does not activate platelets.[6][9] These characteristics make bivalirudin an ideal alternative to heparin.
Bivalirudin clinical studies demonstrated consistent positive outcomes in patients with stable angina, unstable angina (UA), non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) undergoing PCI in seven major randomized trials.[2][7][8][10][11] Patients receiving bivalirudin had fewer adverse events compared to patients that received heparin.[12][13]