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Carefully Consider Post-Op Bleeding Risk when Treating Patients with Chronic Lymphocytic Leukemia


At the current ACMS meeting, Kelsey E. Hirotsu, MD, discussed the bleeding complications seen in patients on ibrutinib for CLL.

Close to 5% of patients with chronic lymphocytic leukemia (CLL) have underlying issues like thrombocytopenia, and because a side effect of ibrutinib is an increased risk of clinically significant bleeding, Mohs surgeons may want to consider holding ibrutinib in these patients, according to a presentation at the American College of Mohs Surgery, being held in Philadelphia, Pennsylvania, this week.

Kelsey E. Hirotsu, MD, from the University of California San Diego, reported these conclusions, which were based on a decade-long retrospective study—from July 2011 to June of 2021—of 362 patients who had been diagnosed with CLL and who underwent Mohs.

The team noted about an eleventh of their patient population, or 32 patients, had a post-surgical complication, including bleeding, dehiscence, and infection.

“Cases where patients were on ibrutinib had the most complications, all of which were related to bleeding. There were 43 cases on ibrutinib, 53 cases on a blood thinner (and no CLL medication), and 93 cases on no medications (no blood thinner nor CLL medication), which accounted for 26 complications; 6 complications occurred in cases on CLL medications other than ibrutinib,” Hirotsu noted in an abstract presented at the meeting. Of the dozen or so that experienced complications, 7 noted no complications once they were taken off the study medication.

“The bleeding risk is likely due to inhibiting platelet activation and drug-induced thrombocytopenia,” Hirotsu said during the presentation, but she said, since dose medication or interruption of medication didn’t appear to impact outcome, it may be best to hold this medication in some of these patients.


Hirotsu KE, Loh TY, Zhang S. Post-operative complications in chronic lymphocytic leukemia patients undergoing Mohs surgery: increased risk of bleeding-related complications from ibrutinib Presented at: American College of Mohs Surgery. May 12-15, 2022. Philadelphia, PA.

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