Bleeding and overanticoagulation with bivalirudin

The specific determinants of bleeding during bivalirudin therapy are not well established. Bivalirudin should be used with caution in patients with prior major bleeding, and other patient-associated factors for increased bleeding risk listed in Patient-associated factors that increase bleeding risk with anticoagulant therapy; seek specialist haematologist advice.

No specific antidote is available to manage bleeding caused by bivalirudin. However, the half-life of bivalirudin is short (approximately 25 minutes). If significant bleeding occurs, stop bivalirudin and provide supportive treatment. If life-threatening bleeding occurs within 3 hours of giving bivalirudin, consider giving activated prothrombin complex concentrate; seek specialist haematologist adviceFrontera, 2016.