How do you decide whether to hold acalabrutinib or zanubrutinib in patients with indolent B-cell lymphoma/leukemias in a perioperative/periprocedural setting?
All 3 non-covalent BTKis have on their FDA label "consider the benefit-risk of withholding for 3-7 days pre and post surgery depending upon the type of surgery and the risk of bleeding". Is the risk sufficiently lower with acala/zanu? Which patients do you worry about a withdrawal syndrome upon holding?
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What is your perioperative management of patients on covalent BTKi's with an upcoming high risk bleeding procedure?
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1 Answer
Mednet Member
Medical Oncology · University of Kansas Cancer Center
Answered on
This is always a point of discomfort among providers, but it can actually be made quite easy.
BTK inhibitors have known antiplatelet effects similar to low-dose aspirin. Consequently, if the surgeon holds aspirin for the planned procedure, I generally recommend that we hold the BTK inhibitor for 3 d...
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