Bleeding Risk With Antiplatelets and Bruton's Tyrosine Kinase Inhibitors in Patients With Percutaneous Coronary...

Area of Science:

• Oncology and Cardiology
• Pharmacology and Hematology

Background:

• Bruton's tyrosine kinase inhibitors (BTKi) are increasingly used for lymphoid malignancies.
• BTKi can cause bleeding due to antiplatelet effects, complicating concurrent antiplatelet therapy.

Purpose of the Study:

• To highlight the clinical challenge of managing patients on BTKi requiring antiplatelet therapy, especially after percutaneous coronary intervention (PCI).
• To inform interventional cardiologists about the bleeding risks associated with BTKi in patients undergoing PCI.

Main Methods:

• Review of current literature on BTKi, antiplatelet therapies, and bleeding risks.
• Analysis of clinical implications for patients with lymphoid malignancies undergoing PCI.

Main Results:

• Existing BTKi have off-target antiplatelet effects, increasing bleeding risk.
• Newer selective BTKi (e.g., acalabrutinib, zanubrutinib) may reduce but not eliminate bleeding risk.
• Concurrent use of BTKi and dual-antiplatelet therapy post-PCI poses significant bleeding concerns.

Conclusions:

• Interventional cardiologists must be aware of BTKi's impact on antiplatelet therapy management.
• Careful consideration of bleeding risk is crucial when managing patients on BTKi who require PCI and antiplatelet treatment.