Bivalirudin

INTRODUCTION

Indications

Used in conjunction with aspirin to reduce the risk of acute ischemic complications in patients with unstable angina who are undergoing percutaneous transluminal angioplasty (PCTA) or percutaneous coronary intervention (PCI). Patients with or at risk of heparininduced thrombocytopenia (HIT) and thrombosis syndrome (HITTS) who are undergoing PCI.

Action

Specifically and reversibly inhibits thrombin by binding to its receptor sites. Inhibition of thrombin prevents activation of factors V, VIII, and XII; the conversion of fibrinogen to fibrin; platelet adhesion and aggregation. Therapeutic Effects: Decreased acute ischemic complications in patients with unstable angina (death, MI, or the urgent need for revascularization procedures).

Adverse Reactions/Side Effects

CNS: headache, anxiety, insomnia, nervousness. CV: hypotension, bradycardia, hypertension. GI: nausea, abdominal pain, dyspepsia, vomiting. Hemat: BLEEDING. Local: injection site pain. MS: back pain. Misc: pain, fever, pelvic pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure). Notify physician or nursing staff immediately of these signs.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an abnormally slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess any back pain or pelvic pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems. Be especially alert for sudden back pain that might indicate abdominal hemorrhage.

• Monitor and report anxiety, nervousness, or other problematic changes in mood and behavior.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician or nursing staff.

Interventions

• Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.

• Instruct patient to report other bothersome side effects such as severe or prolonged fever, sleep loss, or GI problems (nausea, vomiting, indigestion, abdominal pain).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Cleared from plasma by a combination of renal mechanisms and ...