Managing CV toxicities during BTKi treatment
| Emerging atrial fibrillation |
| Manage care using an MDT |
| If other risk factors are limited (eg, CHA2DS2-VASc score = 0 or 1), BTKi therapy can be continued |
| Warfarin less preferred to alternative anticoagulant therapies |
| If recurrent events on ibrutinib, trial with acalabrutinib |
| Emerging HTN |
| Begin regular home blood pressure monitoring |
| New treatments for HTN or adjustments to ongoing treatments should be decided in conjunction with MDT |
| Follow management guidelines and avoid CYP3A4 inhibitors where possible |
| Non-ACEi in the first instance |
| Use combination therapy if needed to attain systolic blood pressure control |
| Emerging CHF |
| Initiate ACEi/ARB/ARNI plus β-blockers as tolerated and according to guidelines |
| Periodic echocardiogram or other EF assessment every 6-12 mo in the setting of active CHF |
| Emerging atrial fibrillation |
| Manage care using an MDT |
| If other risk factors are limited (eg, CHA2DS2-VASc score = 0 or 1), BTKi therapy can be continued |
| Warfarin less preferred to alternative anticoagulant therapies |
| If recurrent events on ibrutinib, trial with acalabrutinib |
| Emerging HTN |
| Begin regular home blood pressure monitoring |
| New treatments for HTN or adjustments to ongoing treatments should be decided in conjunction with MDT |
| Follow management guidelines and avoid CYP3A4 inhibitors where possible |
| Non-ACEi in the first instance |
| Use combination therapy if needed to attain systolic blood pressure control |
| Emerging CHF |
| Initiate ACEi/ARB/ARNI plus β-blockers as tolerated and according to guidelines |
| Periodic echocardiogram or other EF assessment every 6-12 mo in the setting of active CHF |
ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor.