Drug General Information (ID: DDIPKYNAI1)
Drug Name			Bivalirudin		Drug Info		Dicoumarol		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antithrombotic Agents				Anticoagulants
Structure

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

Recommended Action
Management		Until further data are available, coadministration of bivalirudin and all anticoagulants should be undertaken with caution and only after thorough assessment of risks and benefits. Close clinical and laboratory observation for bleeding complications is recommended.

References
1	Bodiford AB, Kessler FO, Fermo JD, Ragucci KR "Elevated international normalized ratio with the consumption of grapefruit and use of warfarin." SAGE Open Med Case Rep 0 (2013): 1-3. [PMID: 27489634]
2	Guo LQ, Yamazoe Y "Inhibition of cytochrome P450 by furanocoumarins in grapefruit juice and herbal medicines." Acta Pharmacol Sin 25 (2004): 129-36. [PMID: 14769198]
3	Product Information. Angiomax (bivalirudin) The Medicines Compny, Cambridge, MA.