Ibrutinib-Associated Cardiac Tamponade with Concurrent Antiplatelet Therapy

Abstract

Ibrutinib is approved for the first-line treatment of chronic lymphocytic leukemia (CLL). A well-known side effect of ibrutinib therapy is increased bleeding risk, which ranges from mild mucocutaneous bleeding to rarely life-threatening hemorrhage. The increased bleeding tendency associated with ibrutinib is thought to be related to its effect on several platelet signaling pathways, which can be exacerbated in the setting of concurrent antiplatelet or anticoagulant therapy. We present an 82-year-old male with CLL on ibrutinib and concurrent antiplatelet therapy who developed cardiac tamponade due to a hemorrhagic pericardial effusion requiring emergent placement of a pericardial window. This case further highlights the risk of major bleeding in patients treated with ibrutinib and concurrent antiplatelet therapy.

Figure 1

Transthoracic echocardiogram (TTE) demonstrating a large pericardial effusion (red arrow).

Figure 2

The effects of ibrutinib on platelet function. Btk, Bruton's tyrosine kinase; Tec, tyrosine kinase expressed in hepatocellular carcinoma; aspirin effects thromboxane A2 receptor (TP); clopidogrel effects adenosine diphosphate (ADP) via p2y12 & p2y1 receptors; von Willebrand factor (VWF) effects glycoprotein Ib (GpIb); collagen binds glycoprotein VI (GpVI); fibrinogen binds integrin αIIbβ3. This work, “The effects of ibrutinib on platelet function,” is a derivative of “The effects of ibrutinib on platelets” by Shatzel et al., retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jth.13651. Used under Creative Commons Attribution-NonCommercial 3.0 Unported (CC BY-NC 3.0) Generic license https://creativecommons.org/licenses/by-nc/3.0/.