Table 4.

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

ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor.