Drug General Information (ID: DDIGB65K7W)
Drug Name			Bivalirudin		Drug Info		Rofecoxib		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antithrombotic Agents				Antiinflammatory Agents
Structure

Mechanism of Bivalirudin-Rofecoxib Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Bivalirudin				Rofecoxib
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Antiplatelet effects
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Bivalirudin and Rofecoxib

Recommended Action
Management		Although COX-2 inhibitors are often preferred over traditional, nonselective NSAIDs in patients who have increased risk for gastrointestinal toxicity, caution is advised during coadministration with anticoagulants or antiplatelet agents. Gastroprotective agents such as H2-receptor antagonists or proton pump inhibitors may be appropriate in high risk patients.

References
1	Product Information. Celebrex (celecoxib). Searle, Chicago, IL.