I have a small skin growth that needs to be removed to be sure it's not cancerous. A minor procedure with local anaesthetic and maybe 1 or 2 stitches.
One doctor said I don't have to stop Calquence (acalabrutinib) for this and another said I have to stop for FIVE DAYS pre- and post-procedure.
The latter seems excessive. I once stopped for 7 days pre and post major surgery (removal of ovary and fallopian tubes) but this mole removal is minor. I prefer to not interrupt the medication.
Anyone out there have experience around this (stopping BTK inhibitor for a minor skin procedure with a couple stitches)?
Thanks!
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Amberesque
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I have recently had a TAVR which is I had my aorta valve replaced and was told there was no need to stop my Calquence which is the same as Acalabrutinib. Then just a few months later I had a trigger finger release and again I was told no need to to stop. Both times no issues at all. I have very low platelets and receive IVIG every 4 weeks. Platelets run 70-80.
BTKi drugs (the 'brutinibs') have an off-target inhibitory effect on tyrosine kinase in platelets affecting their clotting efficiency. So even if you have a good platelet count, you can have a higher risk of bleeding, hence the advice to hold Calquence/acalabrutinib. The official advice on Calquence's health care professional page calquencehcp.com is to "Consider the benefit-risk of withholding CALQUENCE for 3-7 days pre- and post-surgery depending upon the type of surgery and the risk of bleeding."
Dr Rick Furman recently replied with respect to holding ibrutinib while on Paxlovid to the CLL/SLL groups.io forum thus:-
"Re: Question about discontinuing Ibrutinib while on Paxlovid
From: Rick Furman
Date: Wed, 30 Aug 2023 12:07:39 ACST
There really should be no issue with holding ibrutinib for 5 or 10 days. In patients who have recently started treatment, there may be an associate flare, but that would be it. In someone who has been on treatment for a long duration and is in a deep remission, there is no risk for resistance developing from such a short hold."
When I had skin problems taking ibrutinib, I did not stop it for either of my 2 biopsies. Each was 2 stitches if I remember correctly. My platelets never dropped below 80 from a standard CLL induced low of around 100. I do not ooze for cuts or blood draws, nor gums bleed after brushing/flossing.
I had a small biopsy like yours and was told by my CLL specialist that I should continue with my acalabrutinib. When the biopsy came back as melonoma cancer and i had to have Mohs surgery I was taken off my acalabrutinib for 3 days prior and 3 days after.
Thank you to everyone who replied. I am going to stay on the acalabrutinib for the procedure, it's really just a tiny biopsy. Responses like this from my doctor are one reason I don't trust her (she also said she wouldn't be worried if I went off the drug for 6 months!).
Amberesque, I have had bowel surgery (by laparascopic technique) and had to stop Acalabrutinib 5 days before and for 7 days after but I have had several BCCs excised and neither my haematologist nor the dermatologists have suggested suspending Acalabrutinib for those. The wounds were sutured up and all healed perfectly with no increased bleeding.
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