Bivalirudin initial dosing

Please use the following for the initial dose of bivalirudin in heparin-induced thrombocytopenia (HIT):

Creatinine Clearance (CrCl) T 1/2 Recommended initial infusion rate (based on total body weight)
>60 ml/min 25 minutes 0.15 mg/kg/hr
30-60 ml/min 34 minutes 0.08 mg/kg/hr
<30 ml/min 57 minutes 0.05 mg/kg/hr
Dialysis-dependent patients (off dialysis) 3-5 hours 0.02 mg/kg/hr
Dialysis-dependent patients (on dialysis) (25% clearance by HD filters) 0.02 mg/kg/hr

Kiser TH et al. Safety, efficacy and dosing requirements of bivalirudin patients with heparin-induced thrombocytopenia. Pharmacotherapy 2008; 28:1115-24

Dosage adjustment algorithm