Bivalirudin
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Product Description
Bivalirudin is a synthetic 20–amino acid peptide that acts as a direct thrombin inhibitor, derived from hirudin, a natural anticoagulant found in leech saliva. Bivalirudin is designed for clinical use. It works by reversibly inhibiting both circulating and clot-bound thrombin, making it an effective anticoagulant. Bivalirudin is primarily used in percutaneous coronary interventions (PCI) and for patients with heparin-induced thrombocytopenia (HIT). It is cleared mainly by proteolytic cleavage and partially by renal excretion. Recent studies have shown its safety and efficacy as a heparin alternative in various procedures, including carotid artery stenting and in combination with antiplatelet agents like ticagrelor in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.
Synthesis Methods
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Synthetic Origin: Bivalirudin is a synthetic peptide derived from hirudin, a natural anticoagulant found in leech saliva.
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Manufacturing: Typically synthesized through chemical peptide synthesis methods, ensuring purity and consistency for clinical use.
Uses
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Clinical Uses:
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Percutaneous Coronary Intervention (PCI): Used as an anticoagulant during PCI to prevent thrombosis.
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Heparin-Induced Thrombocytopenia (HIT): Preferred anticoagulant for patients with a history of HIT.
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Unstable Angina and Non-ST Segment Elevation Myocardial Infarction (UA/NSTEMI): Used in patients planned for urgent or early intervention.
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Postoperative Aortopulmonary Shunt Thrombosis Prevention: Used in neonates undergoing stage 1 single-ventricle palliation to prevent shunt thrombosis.
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Special Cases:
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Large LA Thrombus: Successfully used in a high-risk patient with a history of HIT and a bioprosthetic mitral valve.
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ECMO Support: Used in patients undergoing extracorporeal membrane oxygenation (ECMO) to prevent thrombosis.
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Properties and Characteristics of Bivalirudin
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Molecular Formula: C₉₈H₁₃₈N₂₄O₃₃
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Molecular Weight: 2180.3 g/mol
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Structure: Synthetic 20-amino acid peptide derived from hirudin (a natural anticoagulant found in leech saliva).
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Mechanism of Action: Direct thrombin inhibitor, binds to both the catalytic site and anion-binding exosite of thrombin, preventing clot formation and platelet activation.
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Pharmacokinetics:
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Half-life: 25 minutes in patients with normal kidney function.
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Metabolism: Primarily cleared by proteolytic cleavage (80%) and partially by renal excretion.
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Chemical and Physical Properties:
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Hydrogen Bond Donor Count: 28
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Hydrogen Bond Acceptor Count: 35
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Rotatable Bond Count: 67
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Topological Polar Surface Area: 902 Ų
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Heavy Atom Count: 155
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Formal Charge: 0
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Complexity: 4950
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Safety and Hazards
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Adverse Effects:
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Bleeding Complications: Major adverse effect is bleeding, which can be severe in some cases.
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Hypotension, Backache, and Nausea: Common side effects.
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Drug-Drug Interactions:
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Increased Bleeding Risk: When used concomitantly with other anticoagulants or antiplatelet agents (e.g., warfarin, heparin, aspirin).
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Contraindications:
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Active Bleeding: Should not be used in patients with active or recent bleeding events.
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Severe Renal Insufficiency: Use with caution in patients with severe renal impairment.
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