Ibrutinib increases perioperative bleeding risk in patients with hematologic malignancies: Study

Minnesota: A new study published in the journal of Dermatologic Surgery suggests that patients with hematologic malignancies who use ibrutinib may experience an increased risk of bleeding, particularly elderly males who take multiple anticoagulants and have lower platelet counts.

Ibrutinib is a first-in-class Bruton tyrosine kinase (BTK) inhibitor that has been shown to be effective in treating a variety of hematologic malignancies, including mantle cell lymphoma, Waldenstrom macroglobulinemia, and chronic lymphocytic leukemia (CLL). Despite the fact that ibrutinib is often well tolerated, clinically severe bleeding episodes have been linked to its treatment. An elevated risk of bleeding has been linked to the Bruton tyrosine kinase inhibitor ibrutinib. The risk of bleeding in ibrutinib patients having dermatologic surgery is poorly understood. Nessa Aghazadeh and colleagues conducted this study in order to ascertain the frequency of bleeding problems related to ibrutinib in patients having dermatologic surgery.

Ibrutinib patients who underwent cutaneous surgery between January 2013 and March 2020 were compared to sex, disease, and age-matched control patients in this retrospective, single-center, case-control research.

The key findings of this study were:

1. There were 116 operations conducted on 64 control patients and 75 operations overall on 37 case patients.

2. The risk of bleeding episodes was statistically significantly higher when using ibrutinib (6/75 [8%] versus 1/116 [0.8%]).

3. Ibrutinib patients who had bleeding were all men, older (mean age 82.7 vs 73.0), and had lower mean platelet counts (104.0 vs 150.5 K/L) than ibrutinib patients who did not have bleeding.

In conclusion, an increased risk of bleeding following dermatologic surgery may be linked to ibrutinib. For dermatological procedures, temporary cessation of ibrutinib should be taken into consideration. Doctors should talk with oncologists about the advantages and disadvantages of stopping ibrutinib 5 days prior to and 3 to 5 days following surgery.

Reference: 

Aghazadeh, N., Jin, M. F., Pride, R. L., O'Byrne, J., & Vidal, N. Y. (2022). Perioperative Bleeding Associated With Ibrutinib in Dermatologic Surgery: A Case–Control Study. In Dermatologic Surgery: Vol. Publish Ahead of Print. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/dss.0000000000003590