Title: Bivalirudin
CAS Registry Number: 128270-60-0
Additional Names: Hirulog-1; hirulog-8
Manufacturers' Codes: BG-8967
Trademarks: Angiomax (Medicines Co.); Angiox (Nycomed); Hirulog (Medicines Co.)
Molecular Formula: C98H138N24O33
Molecular Weight: 2180.29
Percent Composition: C 53.99%, H 6.38%, N 15.42%, O 24.22%
Literature References: Synthetic peptide of 20 amino acids; member of a novel class of bivalent direct thrombin inhibitors. Characterized by an anion binding exosite (ABE) derived from hirudin, q.v., linked to a thrombin catalytic site inhibitor moiety by tetraglycine. Prepn and structure activity study: J. M. Maraganore et al., WO 9102750; eidem, US 5196404 (1991, 1993 both to Biogen); eidem, Biochemistry 29, 7095 (1990). Determn in plasma and whole blood: T. J. Reid, B. M. Alving, Thromb. Haemostasis 70, 608 (1993). Clinical pharmacology: I. Fox et al., ibid. 69, 157 (1993). Clinical study in myocardial infarction: P. Théroux et al., Circulation 91, 2132 (1995); during coronary angioplasty: J. A. Bittl et al., N. Engl. J. Med. 333, 764 (1995). Clinical trial with provisional glycoprotein IIb/IIIa inhibition during percutaneous coronary intervention: A. M. Lincoff et al., J. Am. Med. Assoc. 289, 853 (2003). Review of pharmacology and clinical development: T. D. Gladwell, Clin. Ther. 24, 38-58 (2002); of clinical experience in acute coronary syndromes: J. S. Kalus, M. F. Caron, Expert Opin. Invest. Drugs 13, 465-477 (2004).
Therap-Cat: Antithrombotic.
Keywords: Antithrombotic; Anticoagulant.
Bixins Black Cohosh Blackstrap Molasses Blankophor?R Blasticidin S

Clinical data
Trade names Angiomax
AHFS/ monograph
Pregnancy cat. B (US)
Legal status Rx-only. Not a controlled substance.
Routes Intravenous injection/infusion only
Pharmacokinetic data
Bioavailability N/A (IV application only)
Metabolism Angiomax is cleared from plasma by a combination of renal mechanisms and proteolytic cleavage
Half-life ~25 minutes in patients with normal renal function
CAS number 128270-60-0 YesY
ATC code B01AE06
PubChem CID 16129704
DrugBank DB00006
ChemSpider 10482069 YesY
ChEBI CHEBI:59173 YesY
Synonyms d-Phenylalanyl-l-prolyl-l-arginyl
Chemical data
Formula C98H138N24O33 
Mol. mass 2180.29 g/mol
 N (what is this?)  (verify)

Bivalirudin (Angiomax or Angiox, manufactured by The Medicines Company) is a specific and reversible direct thrombin inhibitor (DTI).[1]

Chemically, it is a synthetic congener of the naturally occurring drug hirudin (found in the saliva of the medicinal leech Hirudo medicinalis).

Bivalirudin is a DTI that overcomes many limitations seen with indirect thrombin inhibitors, such as heparin. Bivalirudin is a short, synthetic peptide that is potent, highly specific, and a reversible inhibitor of thrombin.[1][2][3] It inhibits both circulating and clot-bound thrombin,[3] while also inhibiting thrombin-mediated platelet activation and aggregation.[4] Bivalirudin has a quick onset of action and a short half-life.[1] It does not bind to plasma proteins (other than thrombin) or to red blood cells. Therefore it has a predictable antithrombotic response. There is no risk for Heparin Induced Thrombocytopenia/Heparin Induced Thrombosis-Thrombocytopenia Syndrome (HIT/HITTS).[1] It does not require a binding cofactor such as antithrombin and does not activate platelets.[2][5] These characteristics make bivalirudin an ideal alternative to heparin.

Bivalirudin clinical studies demonstrated consistent positive outcomes in patients with stable angina, unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) undergoing PCI in 7 major randomized trials.[1][3][4][6][7]