Подходы к профилактике и терапии ибрутинибассоциированных кровотечений у взрослых пациентов

Ибрутиниб, необратимый ингибитор тирозинкиназы Брутона (Btk), – высокоэффективный препарат для лечения ряда В-клеточных лимфопролиферативных заболеваний и, с недавних пор, реакции «трансплантат против хозяина». Однако при данной терапии возможно возникновение ряда потенциально опасных осложнений, отчасти связанных с неселективным механизмомдействия препарата. Так, терапия ибрутинибом существенно повышает риски геморрагических осложнений по сравнениюсо стандартной химиотерапией, особенно при сочетании с дезагрегантной или антикоагулянтной терапией, что обусловливаетнеобходимость разработки клинических рекомендаций с учетом индивидуальных рисков по профилактике и терапии геморрагических осложнений у пациентов, получающих ибрутиниб. В настоящее время количество данных о совместном примененииибрутиниба с дезагрегантной или антикоагулянтной терапией ограничено, в связи с чем рекомендуется рассмотреть возможностьальтернативной терапии у пациентов с высоким кардиоваскулярным риском или снижения доз дезагрегантной или антикоагулянтной терапии, если отмена или альтернативная терапия ибрутинибом невозможна. При этом, с учетом антитромбоцитарных эффектов неселективного ингибитора Btk, возможна модификация дезагрегантной терапии у пациентов с низким кардиоваскулярным риском. В данном обзоре суммированы имеющиеся данные по механизмам развития кровотечения и предлагаемымстратегиям по снижению рисков и купированию геморрагических осложнений терапии ибрутинибом.

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