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Table 2 Management and screening strategies for tyrosine kinase inhibitor - associated vascular adverse events

From: Tyrosine kinase inhibitor associated vascular toxicity in chronic myeloid leukemia

Strategy Comments
1. Prevention and risk assessment  
 Cardiovascular risk scoring for VAE risk stratification a) For example, the European Society of Cardiology (ESC) 2012 classification
b) Reliability of such a stratification in guiding TKI drug choice is uncertain
 Atherosclerosis risk factor monitoring and management (hypertension, diabetes mellitus, dyslipidemia, smoking etc.) a) Use of accepted guidelines
b) Especially important for nilotinib and ponatinib
 Echocardiogram Especially relevant for dasatinib as PAH screening
2. Monitoring tools  
 Periodic cardiovascular risk score  
 Atherosclerosis risk factor surveillance (hypertension, diabetes, dyslipidemia, smoking etc.)  
 Subclinical radiological and/or laboratory markers a) May include ABI, US Doppler of selected blood vessels, IMT measurement
b) Clinical implication still investigational.
c) ABI is the most commonly used screening measure in clinical practice
3. Treatment  
 Specific treatment for vascular toxicity Interdisciplinary approach (vascular surgeons, cardiologists/neurologists)
 CML treatment modification options: Factors to be considered:
a) Drug continuation with increased vigilance
b) Drug discontinuation, choosing different TKI
c) Dose reduction
a) Patient-related factors
b) VAE-related factors
c) Disease-related factors
  1. All strategies are for all TKIs unless stated otherwise. See text for full details
  2. TKI tyrosine kinase inhibitor, VAE vascular associated events, PAH pulmonary arterial hypertension, ABI ankle brachial index, US ultrasound, IMT intimal media thickness, CML chronic myeloid leukemia