Perioperative Management of Ruxolitinib in Primary Myelofibrosis During Coronary Artery Bypass Graft Surgery.
Key claim: In a 65-year-old patient with primary myelofibrosis, withholding ruxolitinib for 48 hours around elective CABG with prophylactic corticosteroids permitted uncomplicated surgery without infection, thrombocytopenia, or ruxolitinib discontinuation syndrome.
Abstract
OBJECTIVE: Primary myelofibrosis (PMF) is a myeloproliferative neoplasm frequently treated with the Janus kinase (JAK) inhibitor ruxolitinib. Perioperative management of ruxolitinib presents a clinical dilemma. Continued therapy may increase the risk of infection, cytopenia, and impaired wound healing during major surgery, whereas abrupt discontinuation can precipitate ruxolitinib discontinuation syndrome (RDS), an inflammatory rebound syndrome that may be life-threatening. Currently, there are no established perioperative guidelines for the management of ruxolitinib. METHODS: We report a case of a 65-year-old patient with PMF undergoing elective coronary artery bypass graft (CABG) surgery. RESULTS: Following multidisciplinary discussion with the haematology, ruxolitinib was withheld for 48 hours perioperatively and prophylactic corticosteroids were administered. The patient underwent an uncomplicated surgery and recovery without evidence of infection, thrombocytopaenia, or RDS. CONCLUSION: This case highlights the challenges associated with perioperative ruxolitinib management and emphasises the importance of multidisciplinary decision-making and individualized risk assessment. Reporting such cases contributes to the limited literature on guiding perioperative management of JAK inhibitor therapy in patients undergoing major surgery.
Why this matters
In a 65-year-old patient with primary myelofibrosis, withholding ruxolitinib for 48 hours around elective CABG with prophylactic corticosteroids permitted uncomplicated surgery without infection, thrombocytopenia, or ruxolitinib discontinuation syndrome.