Perioperative management of ruxolitinib in primary myelofibrosis during coronary artery bypass graft surgery

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. We report a case of a 65-year-old patient with PMF undergoing elective coronary artery bypass graft (CABG) surgery. Following multidisciplinary discussion with haematology, Ruxolitinib was withheld for 48 hours perioperatively and prophylactic corticosteroids were administered. The patient underwent uncomplicated surgery and recovery without evidence of infection, thrombocytopenia, or RDS. This case highlights the challenges associated with perioperative Ruxolitinib management and emphasises the importance of multidisciplinary decision-making and individualised risk assessment. Reporting such cases contributes to the limited literature guiding perioperative management of JAK inhibitor therapy in patients undergoing major surgery.