Bivalirudin (Bivalitroban), sold under the brand names Angiomax and Angiox and manufactured by The Medicines Company, is a direct thrombin inhibitor (DTI).Chemically, it is a synthetic congener of the naturally occurring drug hirudin, found in the saliva of the medicinal leech Hirudo medicinalis. Bivalirudin lacks many of the limitations seen with indirect thrombin inhibitors, such as heparin. A short, synthetic peptide, it is a potent and highly specific inhibitor of thrombin that inhibits both circulating and clot-bound thrombin, while also inhibiting thrombin-mediated platelet activation and aggregation. Bivalirudin has a quick onset of action and a short half-life. 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 or heparin-induced thrombosis-thrombocytopenia syndrome. It does not require a binding cofactor such as antithrombin and does not activate platelets. 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 seven major randomized trials. Patients receiving bivalirudin had fewer adverse events compared to patients that received heparin. Indications
US (United States)
Bivalirudin is indicated for use as an anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA). Bivalirudin with provisional use of glycoprotein IIb/IIIa inhibitor (GPI) is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI).
30 Days

The incidence of net adverse clinical events (9.2% vs. 10.0%) and major adverse cardiovascular events (7.6% vs. 7.1%) was reduced by bivalirudin monotherapy versus unfractionated heparin (UFH) plus a GP IIb/IIIa inhibitor with significant reduction in rates of major bleeding (2.4 vs. 4.1%) at 30 days.1-Year Results

Differences in mortality favoring bivalirudin at 30 days and 6 months was maintained at 12 months and demonstrated a 24% risk reduction in death compared to heparin plus GP IIb/IIIa inhibition.BATThe Phase III Bivalirudin Angioplasty Trial (BAT) was a randomized, prospective, double blind, multicenter study in patients with unstable angina undergoing PTCA. The composite endpoint of death, MI or revascularization occurred in 6.2%  of patients treated with bivalirudin and in 7.9% of patients treated with heparin. Significant reductions in clinical events were maintained at 90 days with absolute benefits being sustained through 180 days. The incidence of major hemorrhage for the entire hospitalization period in patients assigned bivalirudin was 3.7% compared to 9.3% in patients randomized to heparin. Guidelines
Bivalirudin has Class I recommendations in multiple national guidelines. US guidelines
EU guidelines

References
External links
Heparin More Effective Than Bivalirudin in Treating Patients During PCI - Diagnostic and interventional cardiology magazine