My doctor has allowed me to go off my low dose ibrutinib, as my numbers have been consistently normal. However, I know that ibrutinib had some beneficial effect or cardiac issues, at least I heard or read. I am trying to weigh the benefit of taking low dose aspirin or resuming my ibrutinib to mitigate strokes/clots. I know not to do both.
Your thoughts?
When you say "I know that ibrutinib had some beneficial effect or (on?) cardiac issues, at least I heard or read.", I expect you are referring to how it and other BTKi drugs have an off target effect on the kinase in platelets, reducing clotting effectiveness. The evidence for the effectiveness of low dose aspirin for having a beneficial effect on cardiac issues has recently been re-evaluated, so it is now considered that unless someone has already had a heart attack (myocardial infarction), the benefit from taking low dose aspirin is likely outweighed by the increased risk of internal bleeding. See mayoclinic.org/diseases-con...
This is something you need to discuss with your cardiologist, particularly given it's common to have lower platelet counts with CLL.
Neil
as usual so helpful. I had a TIA in 2013 but with no symptoms and neurologist said it was "closed." no residual effects I guess. so that is why I was taking baby aspirin before ibrutinib but definitely went off once on ibrutinib as bleeding risk too high. I'm so torn
I have been on Ibrutinib for 9 years. I have only been taking 140mg for the last 8 years. I plan to stay on it as long as it works for me.
Ibrutinib therapy is associated with increased risk of atrial fibrillation (AF) and bleeding. Unfortunately, the higher bleeding risk is not clearly associated with reduced risk of clots. In this study, ibrutinib actually increased the risk of stroke in older patients: sciencedirect.com/science/a...
Use of a medication that reduces platelet clotting is a risk/benefit question as AussieNeil notes. Aspirin is an option; clopidogrel is another which is slighter more effective at reducing stroke risk.
Your doctor (neurologist, cardiologist or Cardio-oncologist - optimal if available) can help you evaluate the choices based on your individual situation & history.
My husband has been on ibrutinib 11 years. He takes 140 mg. Has afib and the cardiologist put him on low-dose aspirin. He has not discontinued ibrutinib despite his CLL numbers being good. Not sure if the cardiologist or the oncologist is doing the right thing. I think it is all a little unclear at this point.
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