Dabigatran etexilate/ibrutinib
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Dabigatran etexilate/ibrutinib Atrial fibrillation, bruising and bleeding: 2 case reports
In a study, two men were described, of whom a 71-year-old man developed atrial fibrillation (AF) during treatment with ibrutinib for chronic lymphocytic leukaemia (CLL), and a 70-year-old man developed bruising and bleeding during treatment with ibrutinib for CLL and dabigatran etexilate as direct oral anticoagulant (DOAC) [not all routes and durations of treatments to reaction onset stated]. Patient 1: A 71-year-old man had a history of CLL since 2009 and hypertension. In April 2018, he was started on ibrutinib 420mg daily. His hypertension was well controlled and the history of AF was not reported. Echocardiography revealed mild left atrial enlargement, dilatation of the ascending aorta and normal left ventricular ejection fraction, which were confirmed by CT angiography. After 15 months on ibrutinib treatment, in July 2019, he developed palpitation and a diagnosis of persistent AF was made. Therefore, his ibrutinib treatment was stopped and he was started on bisoprolol and dabigatran etexilate [dabigatran]. Electrical cardioversion was successfully performed in September 2019. His ibrutinib treatment was re-started with a reduced dose of dabigatran etexilate. Meanwhile, dabigatran etexilate concentration was measured. At a 6 months follow-up, his sinus rhythm was controlled without bleeding complications. Patient 2: A 70-year-old man, who had CLL since 1998, was started on ibrutinib 420mg daily in March 2018. He also had a history of hypercholesterolaemia, hypertension, heart failure, permanent AF and chronic renal failure. His cardiac assessment prior to initiation of ibrutinib revealed good control of HR and hypertension. Also, minor bleedings and bruising were reported while receiving chemotherapy in past. Subsequent, echocardiography showed significant left atrial enlargement and reduced left ventricular ejection fraction to 43%. In October 2018, he was started on oral dabigatran etexilate [dabigatran] 110mg twice daily. However, he developed mild bruising, which led to bleeding. His dabigatran etexilate dose was reduced to 110mg daily. Two weeks later, dabigatran etexilate concentrations were assessed. At a 16 months follow-up, no new bleeding complications were observed. The onset of bruising and bleeding were attributed to ibrutinib and dabigatran etexilate treatment. Lewicka E, et al. Assessment of dabigatran plasma concentration may improve the safety of anticoagulation in patients treated with ibrutinib with concomitant atrial fibrillation. Kardiologia Polska 78: 454-457, No. 5, 25 May 2020. Available from: URL: http://doi.org/10.33963/KP.15255
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Reactions 19 Sep 2020 No. 1822
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