Bivalirudin and hemodialysis

Q; Bivalirudin (Angiomax) is removed by hemodialysis?

A) True
B) False


Answer: A

Bivalirudin is a parenteral direct thrombin inhibitor. It is a hirudin analog which is a mainstay of treatment in Heparin-Induced Thrombocytopenia (HIT). Bivalirudin may get removed by continuous renal replacement therapy (CRRT) and hemodialysis (HD), a very common scenario in ICU patients. 

This is an important clinical consideration as close monitoring of PTT is required to keep anticoagulation within the therapeutic range. In such renal patients, dose can range widely anywhere from 0.01 to 0.07 mg/kg per hour.

#pharmacology
#nephrology
#hematology


References:

1. Wisler JW, Washam JB, Becker RC. Evaluation of dose requirements for prolonged bivalirudin administration in patients with renal insufficiency and suspected heparin-induced thrombocytopenia. J Thromb Thrombolysis 2012; 33:287. 

2.  Tsu LV, Dager WE. Bivalirudin dosing adjustments for reduced renal function with or without hemodialysis in the management of heparin-induced thrombocytopenia. Ann Pharmacother 2011; 45:1185.