What is the half-life of bivalirudin?

Half-life of Bivalirudin

Bivalirudin has a relatively short half-life of 25-36 minutes. 1 This direct thrombin inhibitor's pharmacokinetic profile makes it suitable for specific clinical scenarios requiring short-duration anticoagulation.

Pharmacokinetic Properties

• Half-life: 25-36 minutes in patients with normal renal function 1, 2
• Clearance mechanism:
  • Primarily through proteolytic cleavage (approximately 80%) 1, 2
  • Remaining ~20% cleared by the kidneys 1, 2
• Volume of distribution: 0.2 L/kg 2
• Plasma clearance: 3.4 mL/min/kg in patients with normal renal function 2

Effect of Renal Function on Half-life

Bivalirudin's half-life is significantly affected by renal impairment:

• Normal renal function: 25 minutes 2
• Moderate renal impairment: 34 minutes (clearance reduced by 21%) 2
• Severe renal impairment: 57 minutes (clearance reduced by greater amounts) 2
• Dialysis patients: 3.5 hours (clearance reduced by 70%) 2

Approximately 25% of bivalirudin can be cleared by hemodialysis 2.

Clinical Implications of Short Half-life

The short half-life of bivalirudin has important clinical implications:

1. Advantage in procedural settings: Allows for rapid reversal of anticoagulant effect after discontinuation, beneficial in percutaneous coronary interventions (PCI) 1

2. Risk of early stent thrombosis: The 25-minute half-life means little to no antithrombin activity remains 2 hours after PCI completion, potentially increasing risk of acute stent thrombosis 1

3. No specific reversal agent: Unlike some anticoagulants, bivalirudin has no specific reversal agent, though its short half-life often mitigates this concern 1

4. Monitoring considerations: The therapeutic level can be measured using ecarin clotting time or activated clotting time (ACT) 1, 3

5. Special considerations for cardiopulmonary bypass (CPB): When used in CPB, the short half-life requires avoidance of blood stagnation in the circuit to minimize thrombosis risk 1

Dosing Considerations

Due to its short half-life, bivalirudin dosing strategies may include:

• Bolus followed by continuous infusion to maintain therapeutic levels 1
• Possible post-procedure continuation of infusion (1.75 mg/kg/h for 2-4 hours) to counteract platelet activation and thrombosis risk 1
• Dose reduction in patients with renal impairment 1, 4

Comparison to Other Direct Thrombin Inhibitors

• Argatroban: Half-life of 40-50 minutes, undergoes hepatic clearance 1
• Hirudin derivatives: Half-life of approximately 60 minutes after IV injection and 120 minutes after subcutaneous injection 1

The shorter half-life of bivalirudin compared to other direct thrombin inhibitors makes it particularly useful in settings where rapid offset of anticoagulation is desired.