The Successful Use of Enoxaparin in the Lack of Bivalirudin in a Patient with Chronic Lymphocytic Leukemia and Thrombocytopenia who Underwent Percutaneous Coronary Revascularization

We present a patient with chronic lymphocytic leukemia and thrombocytopenia who underwent a percutaneous coronary intervention. Such patients are at increased risk for ischemic and hemorrhagic complications and the choice of anticoagulant therapy should be made very carefully. Unfractionated heparin or glycoprotein IIb/IIIa inhibitors may cause thrombocytopenia and increased bleeding. Bivalirudin therapy is safer in such patients. However, bivalirudin is not always available. We used enoxaparin, a low-molecularweight heparin, as an anticoagulant in a case in which bivalirudin was not available. No ischemic or hemorrhagic complications were seen in the followup period. We suggest that low-molecular-weight heparin may be eff ective and safe as an alternative to bivalirudin in patients with chronic lymphocytic leukemia and thrombocytopenia when bivalirudin is unavailable.