Use of anticoagulants and antiplatelet in patients with chronic lymphocytic leukaemia treated with single‐agent ibrutinib

Abstract

SummaryBleeding events have been observed among a subgroup of chronic lymphocytic leukaemia (CLL) patients treated with ibrutinib. We analysed data from two studies of single‐agent ibrutinib to better characterize bleeding events and pattern of anticoagulation and antiplatelet use. Among 327 ibrutinib‐treated patients, concomitant anticoagulation (11%) or antiplatelet use (34%) was common, but major bleeding was infrequent (2%). Bleeding events were primarily grade 1, and infrequently (1%) led to discontinuation. Among 175 patients receiving concomitant anticoagulant or antiplatelet agents, 5 had major bleeding events (3%). These events were typically observed in conjunction with other factors, such as coexisting medical conditions and/or concurrent medications.

How I treat CLL patients with ibrutinib

“…The experience of combining long-term anticoagulation with ibrutinib is therefore extremely limited 14 . Antiplatelet agents are more common, reported at 34% in one study 14 , but dual antiplatelet therapy is very rare.…”

“…The experience of combining long-term anticoagulation with ibrutinib is therefore extremely limited 14 . Antiplatelet agents are more common, reported at 34% in one study 14 , but dual antiplatelet therapy is very rare. Generally the latter should be avoided given evidence of increased major bleeding with this combination, without ibrutinib 25 .…”

Ibrutinib in the Treatment of Refractory Chronic Lymphocytic Leukemia

“…С учетом опу-бликованных данных о более высоком риске развития тяжелых геморрагических осложнений у пациентов, принимающих антиагреганты и антикоагулянты, мы стремились не включать в исследование больных, у которых невозможно было отказаться от приема вар-фарина и других антикоагулянтных препаратов [33]. Такие пациенты могли быть включены только при полном отсутствии терапевтической альтернативы.…”

How to use ibrutinib

“…Из 327 пациентов 65 (20 %) одновременно получали антикоагулянтные препараты (антагонисты витамина К, гепарины, инги-биторы II и X факторов). Аспирин одновременно с иб-рутинибом принимали 70 (21 %) пациентов, клопидо-грел -7 (2 %), нестероидные противовос палительные препараты (НПВП) -91 (28 %) [44]. У 8 пациентов разви-лись тяжелые геморрагические ослож нения.…”