Dermed virker bivalirudin initialt som en komplet non- kompetitiv inhibitor af trombin, men ændrer sig over tid til at blive en kompetetiv inhibitor, som muliggør, at initialt inhiberede trombinmolekyler kan interagere med andre koagulationsubstrater og medvirke til koagulation om nødvendigt.
Thus, bivalirudin initially acts as a complete non-competitive inhibitor of thrombin, but transitions over time to become a competitive inhibitor enabling initially inhibited thrombin molecules to interact with other clotting substrates and to coagulation if required.