What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?

Before the availability of venetoclax, the only approved targeted oral therapy for patients with CLL was ibrutinib. Given the lack of alternative options, patients with atrial fibrillation and/or patients on anticoagulation were treated with ibrutinib. Use of anticoagulation with ibrutinib can incre...

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 ...

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...