Bivalirudin Half-Life
Bivalirudin has a half-life of 25 minutes in patients with normal renal function undergoing percutaneous coronary intervention. 1
Half-Life in Normal Renal Function
- The FDA-approved drug label specifies a half-life of 25 minutes in PTCA patients with normal renal function 1
- The American College of Chest Physicians confirms a plasma half-life of 25 minutes after intravenous injection in patients with normal renal function 2
- Some sources cite a range of 25-36 minutes, though 25 minutes represents the most consistent value across guidelines 2
- The anticoagulant effect is immediate (onset 2-4 minutes), and coagulation times return to baseline approximately 1 hour after cessation 2, 1
Half-Life in Renal Impairment
Dose adjustments are required for moderate to severe renal impairment due to significantly prolonged half-life:
- Mild renal impairment (GFR 60-89 mL/min): Half-life remains similar to normal at approximately 25-30 minutes, with no dose adjustment needed 3
- Moderate renal impairment (GFR 30-59 mL/min): Half-life increases to 34 minutes with 21% reduction in clearance 1, 3
- Severe renal impairment (GFR <30 mL/min): Half-life extends to 57 minutes with 68% reduction in clearance 1, 3
- Dialysis-dependent patients: Half-life dramatically increases to 3.5 hours (210 minutes) with 70-77% reduction in clearance 1, 3
Metabolism and Clearance Mechanism
- Bivalirudin undergoes predominantly non-renal elimination through proteolytic cleavage, accounting for 80% of metabolism 2, 4
- Only 20% is excreted unchanged via the kidneys through glomerular filtration, tubular secretion, and reabsorption 2, 1
- This unique pharmacologic profile gives bivalirudin the shortest half-life among marketed direct thrombin inhibitors 4
Clinical Implications of Short Half-Life
- Stent thrombosis risk: 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 2
- No hepatic dose adjustment needed: Unlike argatroban, bivalirudin does not require dose modification for hepatic impairment 2
- Bleeding risk correlation: Major bleeding incidence increases with worsening renal function, though bivalirudin still demonstrates lower bleeding rates than heparin across all renal function categories 3