Bivalirudin (Angiomax) is a direct thrombin inhibitor used as an anticoagulant to treat acute coronary syndromes. Administration is intravenous only and it has a short half-life of 25 minutes.
During unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI), bivalirudin can be used when an early invasive strategy is employed. Bivalirudin is not recommended for initial conservative management during UA/NSTEMI. Bivalirudin can also be used during ST segment elevation myocardial infarction (STEMI).