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Impact of bivaluridin and Genous stent in patients with acute myeloid leukemia undergoing emergency percutaneous coronary angioplasty for acute coronary syndrome

Leukemia volume 26, pages 2300–2301 (2012)Cite this article

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A Corrigendum to this article was published on 06 March 2013

Hematological disorders are considered risk factors for acute and late complications in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). In particular, thrombocytopenia (TP) is associated with a higher risk for bleeding in patients with ACS treated with antithrombotic therapies1 and has been shown to be a predictor of in-hospital mortality in patients undergoing PCI.1 In acute myeloid leukemia (AML), replacement of normal bone marrow with leukemic cells causes anemia, TP, and abnormal white blood cells count. Therefore, these patients represent a challenge for clinicians if PCI strategy for ACS is required. Several trials demonstrated that, in patients with acquired TP, the incidence of bleedings is reduced with bivalirudin treatment, a thrombin-specific anticoagulant, as compared with heparin plus glycoprotein (GP) IIb/IIIa inhibitor use.1, 2 Moreover, patients undergoing PCI with stent deployment require a mandatory dual antiplatelet therapy (DAT) to prevent the risk of stent thrombosis, myocardial infarction and death.3, 4 Accordingly, PCI guidelines indicate the DAT course ranging from 2–4 weeks after plain-old balloon angioplasty, 4–6 weeks after bare-metal stent or up to 6–12 months after drug-eluting stent.5 Here, we report the case of a patient with severe AML who developed chest pain as a result of ACS-non-ST elevation myocardial infarction (NSTEMI).

Taken together, these data suggest that in high-risk patients, such as patients with AML and severe TP, a strategy based on bivalirudin and Genous stent is efficacious and safe in order to achieve both ischemic protection and bleeding risk reduction.

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Authors and Affiliations

  1. Department of Clinical Medicine, Cardiovascular Science and Immunology, Federico II University of Naples, Naples, Italy

    G Galasso, T Niglio, S De Luca, C De Biase & V Parisi

  2. Department of Medicine and Surgery, University of Salerno, Salerno, Italy

    F Piscione

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  1. G Galasso
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  2. T Niglio
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  3. S De Luca
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  4. C De Biase
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Correspondence to G Galasso.

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Galasso, G., Niglio, T., De Luca, S. et al. Impact of bivaluridin and Genous stent in patients with acute myeloid leukemia undergoing emergency percutaneous coronary angioplasty for acute coronary syndrome. Leukemia 26, 2300–2301 (2012). https://doi.org/10.1038/leu.2012.93

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