BTK + anticoaculant/antiplatelet---update

[Agiledog]

Thanks for your replies of a month ago after the cardiologist started 81 mg aspirin. The workup is now done, resulting in dx of CAD based on 2016 CT, and now a stress test and echo both with mild findings, enough to indicate the need for a heart cath. That, of course, carries the possibility of a stent(not to mention the dreaded bypass---aarrggh!). The cardiologist would follow a stent with Plavix or Brilinta for a year to fight clogging, increasing bleeding risk. I met with my NIH acalabrutinib trial Principal Investigator last week. A stent will not exit me from the trial, thankfully. He advises protecting the heart since so many new CLL drugs are within sight of approval. Will stop acalabrutinib a week before. If stented, will remain off acala for a month longer while the antiplatelet and aspirin are started. At 75, there is already some age related bleeding risk along with the acalabruntinib. The NIH team says the studies of combined BTK and antiplatelet/anticoagulant generally cut both ways, some saying high risk, others low, so not yet precise. I have read several of the recent ones. But I have seen on our forum and in the articles, that while this is generally to be avoided, it is done clinically w/o a high percentage of MAJOR bleeding events(intracranial is my greatest worry). I had a subarachnoid hemorrhage 10 years ago with no site of a bleed found and no intervention other getting my occult HTN controlled, which has continued to the present. The neurosurgeon released me at one month f/u and I have had no residual sx or signs, and have continued to work full time. The cardiologist is consulting with the neurosurgeon for guidance, although at 10 years out, does not expect any contraindications.

NIH does not really know how to go ahead other than to move cautiously in clinical management. They do know that many people are treated clinically with combined combined APT, despite the few studies. I am wondering along the following lines. We do know that acala does have some "benefit" of bleeding that would also fight a stent clogging. Would it be reasonable to reduce the f/u anticoagulant/antiplatelet therapy somewhat to reduce risk while still getting the majority of anticlogging benefit when combined with the acalabrutinib? I will pose this to my cardiologist.

Thanks to those who already responded who have experience with combined BTK and anticoagulant/antiplatlet therapy. Anyone else care to chime in?

I feel ever so lucky to be an CLLSA member. Thank you to my one-world family.

Bud

[cllady01 Former Volunteer]

Bud, I am not one of the experienced, but want to say, Wow!---you have a level head about you through all this and I much appreciate that as I am sure your Drs. do, also.

It is so encouraging to have you report how you and the Drs. are working together.

Wishing you the best as the situation gets sorted.

[maggie214]

Bud,

I am also in an Acalabrutinib trial at the NIH and have needed to stop Tx for surgery. Just want to reassure you that the 2 occasions where I had to take time off Tx for about 5 weeks did not impair the effectiveness of the drug.

Although you can infer that the elevated bleeding risk o Acala might confer some benefit, it would be very difficult to measure, so your Drs. will most likely use the time off the drug to assess “normal” before you restart, especially with your Hx.

FYI, after more than 4 years on the drug, I have only ever had bleeds from petechia.

Best of luck on your procedure!

[Agiledog in reply to maggie214]

Maggie,

Just what I needed to hear from a fellow traveller. So glad to know you are doing well. You must have been one of the earliest entrants to the trial. I go for 36 month assessment in December. I have had only slight bruising until recent addition of aspirin has produced minor petechia. But I am just a little squirrely about this anticoag and antiplatet f/u to any stenting.

Thanks for the encouragement. Forward, ho!

Bud