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Tki s and blood thinners

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Hi All

Has anyone any experience of the interaction between any of the tki s and blood thinners.Historically warfarin was the usual blood thinner prescribed but one had to be monitored every month or two months .There are now a range of so called DOACs (Direct Oral Coagulants) that may be taken to protect oneself against AFib (atrial fibrilation) related stroke;the advantages over warfarin are that monitoring of blood levels is not so crucial and it involves only once daily dosing .

My haematologist has sought advice from a coagulation/oncology expert and the thinner Edoxaban (Savaysa) is suggested as best to take alongside imatinib.Imatinib potentiates edoxaban ( slows down absorption ) but the thinner does not affect the uptake of imatinib though, so hence the choice I guess.Dangers are increased bruising and possible bleeding and  there are certain combinations that are not advised-e.g. aspirin,ibuprofen,paracetamol(acetometaphin),naproxen,diclofenac because of the risk of bleeding.

There are some food interactions with blood thinners such as Vit K ,excessive use of leafy greens ,garlic plus St Johns Wort and grapefruit-the latter two should not be taken with imatinib anyway.

Regards

John

Hi.. for as long as I have been on TKI’s..  initially Imatinib, currently Bosutinib which is 3 years now I have also been taken Bisoprolol and Rivaroxaban for arterial fibulation and blood thinning daily..  I was actually prescribed these back in late 2018 before being identified with CML after a routine check up as I was feeling exhausted.. a later blood test in early 2019 diagnosed CML at a critical stage and I was immediately prescribed a chemotherapy course and Imatinib by my consultant.. 2 days later I came out in extreme bruising and was admitted to hospital in agony as my spleen apparently had grown to 3 times its normal size and was working overtime.. appears that in that advanced stage it was not picked up I was actually on a blood thinner which made things a lot worse than it might have been as I bled internally.. they apologised for not picking this up a week later when I was discharged.. 

Anyway 3 years on and still on both forms of medication I feel very well.. BCR is down to 0.3% from being stuck around 1% after 2 years plus of Imatinib though when diagnosed it was up around 70% ! The combinations don’t seem to bother me at all although I have to heed the warnings about bleeding etc and the dangers of rapid blood loss.. but it has no bearing I believe on my CML medication. 

Hi David,

Thank you for sharing your situation and for informing us of what medications you are taking .Your blood thinner Rivaroxaban (Xarelto) is in the class of DOACs and ticks all the boxes of needing no routine blood monitoring,once daily dosing,no known food restrictions,works quickly, and has a reversal agent if you have uncontrolled bleeding.Warfarin has none of these and aspirin has no reversal agent.Mine Edoxaban does not have a reversal agent so I need to be careful

Your Bisoprolol is given so as to regulate your blood pressure and is a beta blocker .AFib can be of different types but generally can be set off or exacerbated by high blood pressure and pulmonary issues,lack of exercise ,poor diet ,binge alcohol consumption,undue stress.For someone with any heart issue Nilotinib is a no no and Dasatinib giving pleural effusions is a risk so I guess your route to Bosutinib was well planned by some expert physicians.

The issue for us is to balance out the risk of bleeding with the risk of AFib related stroke and blood clots .Luckily the interface with tkis is pretty normal.I have to check but in terms of painkillers but possibly only Codeine might be used and not NSAIDS like ibuprofen,diclofenac and ibuprofen .Ibuprofen inhibits the uptake of tkis anyway.Naproxen and aspirin are also out because of risk of bleeding.

My plan is Good diet with lots of Omega 3 s,some exercise but not too much, no alcohol at all(there are some acceptable zero percent versions on the market for social occasions),regular medical check ups and to manage stress .As long as my PCR is below 0.1 % we are in safe territory and when we can get back to undetectable we will halve the dose of imatinib from 400 to 200 mg daily (preferably only using Sandoz generic).

After 16 years on imatinib (dx 16/02/2006) and early prostate cancer now treated by iodine 125 implants apparently zapped and late 70s in age I am planning to try to live a bit longer .

P.S Do you wear a medical alert lanyard or a DOAC card.Amazon do a blood thinners card customised with photo, medication taken, id/nhs no etc etc in the event of an accident or emergency.

I wish you well

John

Thank you John… I dont carry a card but will look into that.. Dave