What is bivalirudin and how does it work?

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Last updated: December 9, 2025View editorial policy

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What is Bivalirudin?

Bivalirudin is a medicine that stops blood clots from forming by blocking a protein in your blood called thrombin. 1

How Does It Work?

  • Bivalirudin attaches directly to thrombin, which is like a key player that helps your blood clot. 1
  • Thrombin normally acts like scissors that cut up proteins to make blood clots stronger and stickier. 1
  • When bivalirudin sticks to thrombin, it blocks thrombin from doing its job, so blood clots can't form as easily. 1
  • The cool thing about bivalirudin is that it works on its own - it doesn't need other helper proteins in your blood to work, which makes it very predictable. 2

What Makes It Special?

  • It works really fast - within 2 to 4 minutes after doctors give it to you through an IV. 3
  • It doesn't last very long - it only stays active in your body for about 25 minutes if your kidneys are working normally. 4, 2, 3, 1
  • Your body breaks it down mostly by cutting it into smaller pieces (80%), and your kidneys get rid of the rest (20%). 4, 2
  • It doesn't stick to other things in your blood except thrombin, so it's very specific. 2, 1

When Do Doctors Use It?

  • Doctors mainly use bivalirudin during heart procedures called percutaneous coronary intervention (PCI), where they open up blocked heart arteries. 1
  • It's especially helpful for people who can't use heparin (another blood thinner) because they have a bad reaction to it called heparin-induced thrombocytopenia. 4, 1
  • It can also be used during heart attacks and unstable chest pain when doctors need to do heart procedures. 4

How Long Does It Work?

  • Your blood goes back to normal clotting about 1 hour after the medicine is stopped. 1
  • If your kidneys don't work well, the medicine stays in your body longer - up to 57 minutes with bad kidney problems, or even 3.5 hours if you need dialysis. 1

Important Safety Information

  • The main risk is bleeding because the medicine stops your blood from clotting. 1
  • Doctors can't use it if you're already bleeding a lot or if you're allergic to it. 1
  • About 25% of the medicine can be removed by dialysis if needed. 1

References

Guideline

Bivalirudin Mechanism and Pharmacology

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Bivalirudin Pharmacokinetics

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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