Drug General Information (ID: DDIIJCKG8A)
Drug Name			Bivalirudin		Drug Info		Defibrotide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antithrombotic Agents				Antiviral Agents
Structure

Mechanism of Bivalirudin-Defibrotide Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Bivalirudin				Defibrotide
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Anticoagulant
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 Defibrotide

Recommended Action
Management		Concomitant use of defibrotide with systemic anticoagulants (except for routine maintenance or reopening of central venous lines) is considered contraindicated. Anticoagulants should be discontinued prior to initiation of defibrotide. Preferably, defibrotide administration should be delayed until the effects of anticoagulant therapy have subsided. Some authorities recommend avoiding use of anticoagulants within 24 hours of defibrotide administration, or within 12 hours in the case of unfractionated heparin. Patients should be monitored for signs of bleeding during defibrotide therapy. If bleeding develops, defibrotide should be discontinued and treatment/supportive care provided until the bleeding stops.

References
1	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
2	Product Information. Defitelio (defibrotide). Jazz Pharmaceuticals, Palo Alto, CA.