• About ANGIOMAX
  • Thrombin's Critical Role
  • Mode of Action
  • Efficacy
  • Safety and Bleeding Rates
  • Value of ANGIOMAX
  • Switching to ANGIOMAX
  • Dosing and Administration
  • Indications and Usage
• Clinical Information
• Bleeding – a Predictor of Mortality
• About PCI
• About HIT/HITTS
• Removal of the Femoral Arterial Catheter
• Helpful Resources

Learn More About: ANGIOMAX Efficacy

Mode of Action Video - See a vivid demonstration of ANGIOMAX in action. Watch the video.

Dosing and Administration

• Instructions for Administration
• Optional Low-Rate Post-percutaneous coronary intervention (PCI) Infusion
• Provisional glycoprotein (GP) IIb/IIIa Criteria
• Dosage in Special Population: Renal Impairment
• ANGIOMAX Bolus and Infusion Rates Calculated by Weight
• Switching Patients Undergoing PCI from Heparin(s) to ANGIOMAX
• Storage Recommendations

Instructions for Administration¹

Angiomax^® (bivalirudin) should be administered as follows:

• ANGIOMAX is intended for intravaneous (IV) injection and infusion after dilution.
  • To each 250 mg vial add 5 mL of Sterile Water for Injection, USP. Gently swirl until all material is dissolved
  • Each reconstituted vial should be further diluted in 50 mL of 5% Dextrose in Water or 0.9% Sodium Chloride for Injection to yield a final concentration of 5 mg/mL (eg, 1 vial in 50 mL; 2 vials in 100 mL; 5 vials in 250 mL)
  • The dose to be administered is adjusted according to the patient’s weight as a bolus dose of 0.75 mg/kg. This should be followed by an infusion of 1.75 mg/kg/hour for the duration of the PCI procedure
  • Continuation of the infusion for up to 4 hours post-procedure is optional, at the discretion of the treating physician
  • Five minutes after the bolus dose has been administered, an activated clotting time (ACT) should be performed and an additional bolus of 0.3 mg/kg should be given, if needed

Dosing and administration considerations

• Optional low-rate post-PCI infusion
  • After 4 hours of the initial infusion, an additional infusion may be initiated at a rate of 0.2 mg/kg/hour for up to 20 hours, if needed
  • If the low-rate infusion is used after the initial infusion, a lower concentration bag of 0.5 mg/mL should be prepared. See Prescribing Information for diluting instructions
• Provisional use of GP IIb/IIIa inhibitor
  • Use of GP IIb/IIIa inhibitor should be considered in the following circumstances:
    decreased Thrombolysis in Myocardial Infarction trial (TIMI) flow (0 to 2) or slow reflow, dissection with decreased flow, new or suspected thrombus, persistent residual stenosis, distal embolization, unplanned stent, suboptimal stenting, side branch closure, abrupt closure, clinical instability, and prolonged ischemia

Special population: renally impaired

• No reduction in the bolus dose is needed
• Patients with a creatinine clearance (CrCl) ≥30 mL/minute should receive the standard infusion of 1.75 mg/kg/hour
• In patients with a CrCl <30 mL/minute, a reduction of the infusion rate to 1.0 mg/kg/hour should be considered
• If a patient is on hemodialysis, the infusion should be reduced to 0.25 mg/kg/hour
• ACT should be monitored in renally impaired patients
• Please refer to Prescribing Information for pharmacokinetic information

SPECIAL PRECAUTION: It is important to note that the pre-PCI ANGIOMAX dose for patients with acute coronary syndrome in the Acute Catheterization and Urgent Intervention Triage StrategY (ACUITY) trial is not an approved dose and is much lower than the approved PCI dose discussed in these instructions.

ANGIOMAX: Predictable Pharmacology^1-3

* Modeled data.

ANGIOMAX achieves dose-related plasma concentrations, rapid onset, and predictable, rapid decrease of effect after discontinuation of the infusion.

The figure indicates the plasma levels after discontinuation of the infusion. With a half-life of 25 minutes, plasma levels of ANGIOMAX fall from therapeutic levels to below 2 µg/mL within approximately 1 hour, thus providing a rationale for sheath removal in most patients.

IV Line Incompatibilities^4,5

Alteplase, Amiodarone HCl, Amphotericin B, Chlorpromazine HCl, Diazepam, Dobutamine HCl (at 12.5 mg/mL)*, Prochlorperazine edisylate, Reteplase, Streptokinase, Vancomycin HCl

* Dobutamine HCl at a concentration of up to 4 mg/mL was reported to be physically compatible with ANGIOMAX; however; at a concentration of 12.5 mg/mL it was observed to be physically incompatible.

View the ANGIOMAX IV Line Compatibility Chart

ANGIOMAX Bolus and Infusion Rates Calculated by Weight¹

Print the Dosing Table

Switching Patients Undergoing PCI From Heparin(s) to ANGIOMAX⁶

LMWH=low-molecular-weight heparin.

For additional switching information, visit Switching to ANGIOMAX.

Storage Recommendations¹

Store ANGIOMAX dosage units at 20°C-25°C (68°F-77°F). Excursions to 15°C-30°C permitted. (See USP Controlled Room Temperature.) Do not freeze reconstituted or diluted ANGIOMAX. Reconstituted material may be stored at 2°C-8°C for up to 24 hours. Diluted ANGIOMAX with a concentration of between 0.5 mg/mL and 5 mg/mL is stable at room temperature for up to 24 hours. Discard any unused portion of reconstituted solution remaining in the vial.