Please select the option that best describes you:
Topics:
Hematologic Malignancies • Medical Oncology • Leukemia • Internal Medicine • CLL • Hematology • Hemostasis/Thrombosis • Cardiology
What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?
Do you feel comfortable with BTK inhibitors in these patients?
In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the acalabrutinib arm was highest in those with a-fib history (10 pts=40%, 6 with gr3+ toxicity.) Does this affect your use?
Answer from: Medical Oncologist at Academic Institution
In a patient with atrial fibrillation, I would be comfortable initiating a BTKi especially with approval of the 2nd generation BTKi which has less impact on cardiac arrhythmias and/or risk of bleeding. I would be hesitant with starting ibrutinib, not for the atrial fibrillation as I have co-managed ...
Answer from: Medical Oncologist at Academic Institution
For CLL patients who have atrial fibrillation or a history of this, I would follow the approach of using one of the second generation BTKi (acalabrutinib or zanabrutinib) which have a lower frequency of provoking this complication than ibrutinib. For patients requiring anticoagulation for atrial fib...
Should we stratify risk first? So if they are low...