A Fib on Imbruvica how common is it

[Timree]

Have had a few bouts of A Fib . Some pretty severe. Is it common with Ibrutinib as a side effect ? Secondly can it result in increased risk of clots. Thanks.

[Vizilo]

I’ve been on Acalabrutinib for two years and recently had my first two AFib events. Both times it went back to normal rhythm within 8 hours (spontaneous remission). The second time occurred the day after I started taking Paxlovid for COVID. Initially, my cll specialist recommended Acalabrutinib over Ibrutinib because of the lower risk of Afib.

Interestingly no AFib for first 21 months of Acalabrutinib then twice in 3 weeks then nothing for last 2 months. So, does AFib occur as a result of the cumulative effect of targeted therapy, is it a combination of meds, stress, dehydration, COVID itself (second time) or something else? Apparently very difficult to tie down.

The first time it occurred the emergency room physician (in consultation with the on-call hematologist) prescribed a low dosage anti-coagulant (2.5mg Apixaban) to reduce the potential for a stroke. My family physician was not too concerned but I insisted on a referral to a cardiologist, just to be sure.

[lankisterguy Volunteer]

Hi Timree,

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Here is a list of the 162 times Afib was mentioned in past postings.

healthunlocked.com/cllsuppo...

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There have been several recent webinars where our CLL experts shared data from studies that compared and contrasted the rates of Afib and hypertension in CLL patients. Those indicated that patients on Ibrutinib for several years (e.g. more than 3- 5 years) had increasing heart issues in the 10 to 15% range. And Acalabrutinib and Zanubrutinib patients showed about half that rate. However the latter two drugs have not been approved long enough to have significant 5 year data.

In many cases, an experienced cardiologist was able to control the issues with common heart medication. The issue with blood clot risk was mentioned suggesting careful balancing of added blood thinners, since Ibrutinib is a known blood thinner.

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Here is a video link from a USA Cardiologist (Javed Moslehi, MD) discussing the issues with several of the kinase treatments for different cancers.

youtube.com/watch?v=EZiQpdU...(Not working as expected?)

youtube.com/watch?v=yE6pVhA...(Not working as expected?)

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Len

[Timree in reply to lankisterguy]

Thank you Len . That was very helpful and i will post again when I get the cardiology test results and when or if I am put on thinners.. Seems counterintuitive that thinners are recommended to treat when Ibrutinib is a thinner in itself it would seem. Will be interesting to see what he says. Tim

[W00dfin]

My hematologist stopped the Ibrutinib after my afib was diagnosed. The afib didn’t resolve in the absence of Ibrutinib. I had to undergo the Cardioversion procedure to stop the afib. Since my labs had been looking good my hematologist has followed me on no treatment other than IVIG. Still no reoccurrence after 3 years!

[Timree in reply to W00dfin]

The Ibrutinib has it would seem has worked very well for me over the past 2 years and it's disappointing that I have late onset afib when all else is going well. Anyway time will tell.

[W00dfin in reply to Timree]

I had been on Ibrutinib 3 years when my afib was diagnosed.

[virdieblue]

This just appeared in my mail today

targetedonc.com/view/ibruti... Ibrutinib-Treated Patients Show Higher Risk of Developing Cardiotoxicity

Feb 23, 2023

Nichole Tucker

It shows A fib with a 5%-16% occurrence rate.

Virginia

[Timree]

Thank you 60ish. Was at doc today and he says need to be careful as increased risk of stroke with afib. Going to have tests etc. Will post when cardiology reports. Tim