Perioperative Management of Zanubrutinib

Preoperative Considerations

The American Society of Clinical Oncology recommends discontinuing zanubrutinib 3-7 days prior to elective surgical procedures to reduce perioperative bleeding risk 1, 2
The duration of zanubrutinib hold should be determined by the bleeding risk of the procedure, patient's baseline platelet count and bleeding history, and concurrent anticoagulation or antiplatelet therapy 1
Patients should be evaluated for neutropenia, which occurs in 29% of patients, thrombocytopenia, present in approximately 11% of patients, and anemia, which occurs in 12% of patients 3
Cardiac status should be assessed, particularly for atrial fibrillation, though zanubrutinib has a favorable 4% incidence compared to 17% with ibrutinib 3, 1

Anesthesia providers should anticipate increased bleeding tendency even after appropriate drug discontinuation, as zanubrutinib affects platelet function through BTK inhibition 1
Blood products should be readily available, particularly in patients with baseline cytopenias 3, 1
Regional anesthesia requires careful consideration due to bleeding risk, particularly neuraxial techniques 1

Zanubrutinib should be resumed as soon as hemostasis is secure and oral intake is tolerated 1, 2
Complete blood count should be monitored closely postoperatively, as neutropenia may require granulocyte colony-stimulating factor support 3, 1, 2
Patients should be assessed for bleeding complications, particularly in the first 48-72 hours after resumption 1

Zanubrutinib is preferred over ibrutinib in patients with pre-existing cardiac disease due to lower atrial fibrillation rates 3, 2
Patients with baseline cytopenias should be considered for preoperative G-CSF support, and elective surgery should be delayed if possible in patients with severe thrombocytopenia until counts improve 3, 1, 2