ibrutinib and bleeding risk

[deleted131481]

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Anyone familiar with this medication? Used for some lymphomas and leukemia, apparently some higher bleeding risk. It affects platelet function. UptoDate says risks/benefits of holding 3-7 days.

I have a patient on this scheduled for TFESI so thinking of just continuing (recently started doing these on blood thinners). If ILESI I think I would send note to oncologist to stop 5-7 days.

Thoughts?

 

[lobelsteve]

More worried about the immunocompromise from the steroids than the risk of bleeding.

 

[Orin]

Anyone familiar with this medication? Used for some lymphomas and leukemia, apparently some higher bleeding risk. It affects platelet function. UptoDate says risks/benefits of holding 3-7 days.

I have a patient on this scheduled for TFESI so thinking of just continuing (recently started doing these on blood thinners). If ILESI I think I would send note to oncologist to stop 5-7 days.

Thoughts?

I do a bit of cancer pain but I was not familiar with this one. Thanks for mentioning it as I'll look out for it in the future. It looks like it is has a uniquely elevated risk for bleeding due to on-target and off-target mechanisms on platelet function.

Ibrutinib-associated bleeding; pathogenesis, management, and risk reduction strategies - PMC

Ibrutinib is an irreversible inhibitor of Bruton’s tyrosine kinase (Btk) that has proven to be an effective therapeutic agent for multiple B-cell mediated lymphoproliferative disorders. Ibrutinib, however, carries an increased bleeding risk compared ...

www.ncbi.nlm.nih.gov

Management of elective and unplanned procedures.​

Ibrutinib should be held for 7 days prior to major procedures, as the antiplatelet effects of ibrutinib have been shown to be fully reversed after a week off therapy.[20, 21] Ibrutinib can be restarted 1–3 days postoperatively.[11, 13] The risk of bleeding during urgent, unplanned procedures can be mitigated with platelet transfusion to achieve 50% fresh platelets.[20] The time since the last dose of ibrutinib should be considered if transfusing platelets, as outlined above.[21]

For an ILESI I would check platelet count the week of the ESI and assess them for bleeding based on petechiae, oozing gums, etc on the day of, as the risk of a catastrophic bleed for a non-catheter based injection is very low compared to the cancer risk. You could follow the guidelines above and hold for 7 days. I would hold for 7 days for higher risk things like SCS trials. The half life is short but the need for platelets to bounce back is the struggle.

For TFESI, I would agree and just go