Bivalirudin Half-Life
Bivalirudin has a plasma half-life of 25 minutes after intravenous injection in patients with normal renal function. 1, 2
Half-Life in Normal Renal Function
- The elimination half-life is approximately 25 minutes in patients undergoing percutaneous coronary intervention (PCI) with normal renal function 1, 2
- Some guidelines cite a range of 25-36 minutes for the half-life 1
- Coagulation times return to baseline approximately 1 hour following cessation of bivalirudin administration 2
- The onset of anticoagulant action is rapid at 2-4 minutes 1
Half-Life in Renal Impairment
The half-life is significantly prolonged in patients with renal dysfunction, requiring dose adjustments. 1
- Mild renal impairment (CrCl 60-89 mL/min): Half-life remains similar to normal renal function at approximately 30 minutes 3
- Moderate renal impairment (CrCl 30-59 mL/min): Half-life increases to 34 minutes with a 21% reduction in clearance 2, 3
- Severe renal impairment (CrCl <30 mL/min): Half-life extends to 57 minutes with a 68% reduction in clearance 2, 3
- Dialysis-dependent patients: Half-life is dramatically prolonged to 3.5 hours with a 70-77% reduction in clearance 2, 3
Clearance Mechanism
- Bivalirudin undergoes predominantly non-renal elimination through proteolytic cleavage (80% enzymatic metabolism) 1, 2
- Only 20% is excreted unchanged via the kidneys through glomerular filtration 1, 2
- Approximately 25% of bivalirudin is cleared by hemodialysis 2
- This predominantly enzymatic clearance distinguishes bivalirudin from other direct thrombin inhibitors like lepirudin (primarily renal) and argatroban (hepatic) 1
Clinical Implications
- The short half-life means bivalirudin provides little to no antithrombin activity 2 hours after discontinuation, which has been associated with increased acute stent thrombosis risk in some studies 1
- Dose adjustments are required for patients with moderate to severe renal impairment but not for hepatic impairment 1, 2
- The rapid clearance necessitates continuous infusion for sustained anticoagulation during procedures 2