Mary Ann Anderson, Farrukh T. Awan, Leanne Berkahn, Kyle Crassini, Hui-Peng Lee, Paula Marlton, Stephen P. Mulligan, Mark Nolan, Constantine Tam, Aaron L. Sverdlov
{"title":"澳大利亚和新西兰关于布鲁顿酪氨酸激酶抑制剂治疗慢性淋巴细胞白血病患者心血管管理的共识声明。","authors":"Mary Ann Anderson, Farrukh T. Awan, Leanne Berkahn, Kyle Crassini, Hui-Peng Lee, Paula Marlton, Stephen P. Mulligan, Mark Nolan, Constantine Tam, Aaron L. Sverdlov","doi":"10.1111/imj.70159","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Bruton's tyrosine kinase inhibitors (BTKi) reduce mortality and morbidity in chronic lymphocytic leukaemia (CLL) but have an association with cardiotoxicities, including hypertension, atrial fibrillation (AF), ventricular arrhythmias (VA) and bleeding. There is currently no specific advice for Australian and New Zealand clinicians.</p>\n </section>\n \n <section>\n \n <h3> Aim</h3>\n \n <p>In this paper, we aim to provide evidence-based recommendations for risk assessment, monitoring and managing cardiovascular (CV) toxicity to optimise patient outcomes.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A multidisciplinary roundtable was held on 21 August 2023 to discuss clinical evidence and derive consensus recommendations, which were graded according to class and level of evidence.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Baseline CV risk assessment, including patient history, blood pressure (BP), pulse and ECG, is recommended in all patients before starting a BTKi. Management and monitoring requirements should reflect the patient's risk status. A target BP of 140/90 mmHg should be achieved (or 130/80 mmHg in high-risk patients or those with CV disease). In patients with pre-existing AF, closer monitoring is recommended in consultation with cardiology. Oral anticoagulation is generally warranted in patients with a CHA2DS2-VASc score of ≥2 in males or ≥3 in females. BTKi should be withheld for 3 days before and after a minor procedure and 7 days prior to or post a major procedure. Due to the risk of VA and sudden death, BTKi is generally contraindicated in patients with previous VA, severe or uncontrolled heart failure or hypertension. Multidisciplinary care aims to minimise complications and improve treatment outcomes.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Further research should be directed at validating CV screening tools and measuring outcomes based on these recommendations.</p>\n </section>\n </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 9","pages":"1556-1569"},"PeriodicalIF":1.5000,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70159","citationCount":"0","resultStr":"{\"title\":\"Australia and New Zealand consensus statement on the cardiovascular management of patients with chronic lymphocytic leukaemia treated with Bruton's tyrosine kinase inhibitors\",\"authors\":\"Mary Ann Anderson, Farrukh T. Awan, Leanne Berkahn, Kyle Crassini, Hui-Peng Lee, Paula Marlton, Stephen P. Mulligan, Mark Nolan, Constantine Tam, Aaron L. Sverdlov\",\"doi\":\"10.1111/imj.70159\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Bruton's tyrosine kinase inhibitors (BTKi) reduce mortality and morbidity in chronic lymphocytic leukaemia (CLL) but have an association with cardiotoxicities, including hypertension, atrial fibrillation (AF), ventricular arrhythmias (VA) and bleeding. There is currently no specific advice for Australian and New Zealand clinicians.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>In this paper, we aim to provide evidence-based recommendations for risk assessment, monitoring and managing cardiovascular (CV) toxicity to optimise patient outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A multidisciplinary roundtable was held on 21 August 2023 to discuss clinical evidence and derive consensus recommendations, which were graded according to class and level of evidence.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Baseline CV risk assessment, including patient history, blood pressure (BP), pulse and ECG, is recommended in all patients before starting a BTKi. Management and monitoring requirements should reflect the patient's risk status. A target BP of 140/90 mmHg should be achieved (or 130/80 mmHg in high-risk patients or those with CV disease). In patients with pre-existing AF, closer monitoring is recommended in consultation with cardiology. Oral anticoagulation is generally warranted in patients with a CHA2DS2-VASc score of ≥2 in males or ≥3 in females. BTKi should be withheld for 3 days before and after a minor procedure and 7 days prior to or post a major procedure. Due to the risk of VA and sudden death, BTKi is generally contraindicated in patients with previous VA, severe or uncontrolled heart failure or hypertension. 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Australia and New Zealand consensus statement on the cardiovascular management of patients with chronic lymphocytic leukaemia treated with Bruton's tyrosine kinase inhibitors
Background
Bruton's tyrosine kinase inhibitors (BTKi) reduce mortality and morbidity in chronic lymphocytic leukaemia (CLL) but have an association with cardiotoxicities, including hypertension, atrial fibrillation (AF), ventricular arrhythmias (VA) and bleeding. There is currently no specific advice for Australian and New Zealand clinicians.
Aim
In this paper, we aim to provide evidence-based recommendations for risk assessment, monitoring and managing cardiovascular (CV) toxicity to optimise patient outcomes.
Methods
A multidisciplinary roundtable was held on 21 August 2023 to discuss clinical evidence and derive consensus recommendations, which were graded according to class and level of evidence.
Results
Baseline CV risk assessment, including patient history, blood pressure (BP), pulse and ECG, is recommended in all patients before starting a BTKi. Management and monitoring requirements should reflect the patient's risk status. A target BP of 140/90 mmHg should be achieved (or 130/80 mmHg in high-risk patients or those with CV disease). In patients with pre-existing AF, closer monitoring is recommended in consultation with cardiology. Oral anticoagulation is generally warranted in patients with a CHA2DS2-VASc score of ≥2 in males or ≥3 in females. BTKi should be withheld for 3 days before and after a minor procedure and 7 days prior to or post a major procedure. Due to the risk of VA and sudden death, BTKi is generally contraindicated in patients with previous VA, severe or uncontrolled heart failure or hypertension. Multidisciplinary care aims to minimise complications and improve treatment outcomes.
Conclusion
Further research should be directed at validating CV screening tools and measuring outcomes based on these recommendations.
期刊介绍：
The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.
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