Anticoagulants Used in Cardiac Catheterization of Patients With Chronic Lymphocytic Leukemia: A Case Report and Overview

Percutaneous coronary intervention (PCI) is one of the most frequently performed invasive therapeutic procedures and plays a key role in the long-term survival of patients with ischemic heart disease. Over 965,000 angioplasties are performed annually in the United States alone. While the technique and equipment have undergone significant revisions and improvement, the medical community will still benefit from more data and guidance on the optimal selection of mandatory peri-operation anticoagulation in specific, high-risk populations. Many of these procedures are performed on high-risk individuals who have an inherently higher risk of hemorrhage or thrombosis. Unfractionated heparin is the most popular choice in the general population, however, its use carries certain limitations. Here we will describe the use of an uncommonly used anticoagulant in a patient being actively treated for leukemia. We will also discuss the unique properties and benefits of the four most frequently used anticoagulants during a cardiac angioplasty. Our team describes the successful use of bivalirudin during an urgent PCI in a 71-year-old female with eight previous stents that was followed by an uncomplicated recovery period. Our experience contributes to a small, but growing, body of evidence that bivalirudin may be a safe choice to use in lieu of unfractionated heparin in patients with underlying oncological disease. Our patient had several comorbidities that significantly increased their risk of bleeding. We will also review the clinical trials that compared the four most commonly used anticoagulants during cardiac catheterization.