Anticoagulation for Angioplasty in a Patient With CLL: Case Report
Posted: Wednesday, May 19, 2021
The uncommon anticoagulant bivalirudin was used perioperatively when angioplasty was performed in a 71-year-old patient in active treatment for chronic lymphocytic leukemia (CLL). This case report, written by Anton Mararenko, DO, of the Jersey Shore University Medical Center, Hackensack, and colleagues, was published in Cureus.
“We believe that bivalirudin may be a promising agent and the most reliable for use in high-risk populations such as patients with an inherently high risk of clotting or bleeding,” concluded the authors.
The patient had a medical history significant for coronary artery disease, treated with several angioplasties and eight drug-eluting stents and CLL. She had received rituximab for CLL treatment 2 weeks before admission for midsternal, nonradiating chest pain on exertion that became refractory to sublingual nitroglycerin. She had a white blood cell count of 224 k/mL on admission, with a 93.9% lymphocytic predominance as well as normocytic anemia and a hemoglobin of 9.9 g/dL. An electrocardiogram was significant for a left bundle branch block with a prolongation of the PR interval. She was anticoagulated with intravenous bivalirudin, a drug-eluting stent was placed in the right coronary artery, and bivalirudin was discontinued after the procedure. She continued to take 81 mg of aspirin and 60 mg of prasugrel postoperatively.
The treatment team opted for the direct thrombin inhibitor bivalirudin for this patient, given her CLL. Bivalirudin has been reported to have a reduced risk of bleeding compared with unfractionated heparin (3.8% vs. 9.8%) and a reduced rate of 30-day major rebleeding (4.9% vs. 8.3%) in patients undergoing percutaneous coronary intervention for myocardial infarction. On the other hand, there have also been reports of a higher risk of 24-hour stent thrombosis with bivalirudin compared with unfractionated heparin (1.3% vs. 0.3%).
Disclosure: The authors reported no conflicts of interest.