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Published on: July 9, 2020
Ibrutinib-Associated Cardiac Tamponade with Concurrent Antiplatelet Therapy
Jennifer L Miatech1, John H Hughes1, Dillon K McCarty1
1Baton Rouge General Internal Medicine Residency Program, Baton Rouge General Medical Center, Baton Rouge, LA, USA.
Insights
Ibrutinib increases bleeding risk in chronic lymphocytic leukemia (CLL) patients. Concurrent antiplatelet therapy can exacerbate this, leading to severe events like cardiac tamponade.
Area of Science:
- Oncology
- Hematology
- Pharmacology
Background:
- Ibrutinib is a first-line treatment for chronic lymphocytic leukemia (CLL).
- A known side effect of ibrutinib is an increased risk of bleeding.
- This risk is potentially heightened with concomitant antiplatelet or anticoagulant medications.
Observation:
- An 82-year-old male with CLL receiving ibrutinib and antiplatelet therapy presented with cardiac tamponade.
- The condition was caused by a hemorrhagic pericardial effusion.
- Emergent pericardial window placement was required.
Findings:
- This case illustrates a severe bleeding complication in a patient on combined ibrutinib and antiplatelet therapy.
- Ibrutinib's mechanism affects platelet function, increasing hemorrhage risk.
- Concurrent use of antiplatelet agents amplifies this risk.
Implications:
- Clinicians must carefully weigh the risks and benefits of ibrutinib, especially when combined with antiplatelet agents.
- Enhanced monitoring for bleeding complications is crucial in such patients.
- This case underscores the need for vigilance regarding major hemorrhage in CLL patients on dual therapy.
Abstract:
Ibrutinib is approved for the first-line treatment of chronic lymphocytic leukemia (CLL). A well-known side effect of ibrutinib therapy is increased bleeding risk, which ranges from mild mucocutaneous bleeding to rarely life-threatening hemorrhage. The increased bleeding tendency associated with ibrutinib is thought to be related to its effect on several platelet signaling pathways, which can be exacerbated in the setting of concurrent antiplatelet or anticoagulant therapy. We present an 82-year-old male with CLL on ibrutinib and concurrent antiplatelet therapy who developed cardiac tamponade due to a hemorrhagic pericardial effusion requiring emergent placement of a pericardial window. This case further highlights the risk of major bleeding in patients treated with ibrutinib and concurrent antiplatelet therapy.
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