A patient with chronic lymphocytic leukemia and thrombocytopenia who underwent percutaneous coronary intervention (PCI) and stenting is presented. Patients with these concomitant diseases who require invasive cardiac procedures are at increased risk for ischemic and bleeding complications and the choice of anticoagulation in these patients is critical. In the present case, anticoagulation was achieved with the direct thrombin inhibitor bivalirudin. No complications were reported, and the patient tolerated the procedure well. This case suggests that bivalirudin may be safely used in patients who are at an increased risk of bleeding undergoing PCI.