Ibrutinib in patients with atrial fibrillation - the challenge of thromboembolic prophylaxis

Rom J Intern Med. 2021 Aug 26;59(3):270-277. doi: 10.2478/rjim-2021-0015. Print 2021 Sep 1.

Abstract

Ibrutinib is a novel drug used in haematological malignancies. Its use is associated with an increased risk of atrial fibrillation (AF), which, in turn, exposes patients to embolic risk, including stroke. Reducing this risk requires anticoagulant therapy which is a matter of concern in the context of the increased bleeding risk of patients with haematological malignancies. In this context the presence of thrombocytopenia related to haematological disorder, ibrutinib-anticoagulants and ibrutinib-platelets interactions contribute to the amplification of the problem. The correct assessment of the thrombosis vs. haemorrhage balance represents a significant challenge for the clinician. In this paper we discuss practical issues related to anticoagulation in patients treated with ibrutinib and incident AF.

Keywords: anticoagulation; atrial fibrillation; haemorrhagic risk; ibrutinib; thromboembolic prophylaxis.

MeSH terms

  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Adenine / therapeutic use
  • Anticoagulants* / adverse effects
  • Anticoagulants* / therapeutic use
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Atrial Fibrillation / chemically induced*
  • Hematologic Neoplasms / drug therapy*
  • Hemorrhage / chemically induced*
  • Humans
  • Piperidines / adverse effects*
  • Piperidines / therapeutic use
  • Risk Factors
  • Stroke / prevention & control
  • Thromboembolism / etiology
  • Thromboembolism / prevention & control*

Substances

  • Anticoagulants
  • Antineoplastic Agents
  • Piperidines
  • ibrutinib
  • Adenine