SOHO 2026 Annual Meeting

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:

Retrospective cohort study using TriNetX network (86 healthcare organizations)
Adults (18+) with CLL receiving BTKi therapy who developed atrial fibrillation
Compared patients receiving anticoagulation (DOAC or warfarin) with those not receiving anticoagulation
Outcomes: all-cause mortality, stroke, bleeding, MI, VTE, ICU admission, and hospitalization
Propensity score matching (PSM) performed using demographics, comorbidities, medications, procedures, and laboratory variables
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.

SOHO 2026 Annual Meeting

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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