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SOHO 2026 Annual Meeting
September 9 - 12, 2026 | George R. Brown Convention Center, Houston, Texas
CLL - 860
Mortality and Bleeding Tradeoffs Associated With Oral Anticoagulation in BTK Inhibitor-Treated Chronic Lymphocytic Leukemia Patients With Atrial Fibrillation/Flutter: A Propensity-Matched TriNetX Analysis
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Chronic Lymphocytic Leukemia (CLL)
Mortality and Bleeding Tradeoffs Associated with Oral Anticoagulation in BTK Inhibitor-Treated Chronic Lymphocytic Leukemia Patients with Atrial Fibrillation/Flutter: A Propensity-Matched TriNetX Analysis
Introduction: Bruton tyrosine kinase inhibitors (BTKi) have improved outcomes in chronic lymphocytic leukemia (CLL) but are associated with an increased risk of atrial fibrillation/flutter (AF) and bleeding. Anticoagulation for AF in BTKi-treated patients is a clinical dilemma, requiring a balance between stroke prevention and hemorrhagic complications.
Aim: To compare thromboembolic and hemorrhagic outcomes among patients with CLL receiving BTK inhibitors who develop atrial fibrillation/flutter and are treated with versus without anticoagulation.
Methods:
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Retrospective cohort study using TriNetX network (86 healthcare organizations)
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Adults (18+) with CLL receiving BTKi therapy who developed atrial fibrillation
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Compared patients receiving anticoagulation (DOAC or warfarin) with those not receiving anticoagulation
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Outcomes: all-cause mortality, stroke, bleeding, MI, VTE, ICU admission, and hospitalization
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Propensity score matching (PSM) performed using demographics, comorbidities, medications, procedures, and laboratory variables
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Relative risks, hazard ratios, and 95% confidence intervals calculated
Conclusion: Anticoagulation was linked to lower mortality but a significantly increased bleeding risk, without a statistically significant reduction in stroke. These findings underscore the complex clinical trade-offs involved and highlight the need for further studies that assess anticoagulant class, CHA₂DS₂-VASc and HAS-BLED risk scores, and antiplatelet exposure.