Ponatinib has clear contraindications for patients with severe cardiovascular disease and uncontrolled hypertension, and strict risk assessment and adherence to specific medication guidelines are necessary. The following provides a detailed explanation of the specific restrictions and alternative solutions for taboo populations.

1. Patients with severe cardiovascular disease

Punitinib may exacerbate heart failure, myocardial infarction, or arrhythmia. Electrocardiogram and echocardiography should be evaluated before treatment, and NYHA grades III-IV patients are contraindicated. Individuals with a history of arterial thrombosis need to weigh the benefit risk ratio.

(1) Acute coronary syndrome

It is contraindicated for patients who have experienced acute myocardial infarction or unstable angina within 6 months. Stable coronary heart disease patients should use antiplatelet therapy under the monitoring of a cardiovascular specialist and optimize it.

(2) Severe arrhythmia

Patients with QTc interval>500ms or bradycardia requiring pacemaker treatment are contraindicated. During the medication period, avoid using other drugs that prolong the QT interval in combination, and monitor the electrocardiogram monthly.

2. Uncontrolled hypertensive patients

Patients with baseline blood pressure ≥ 140/90mmHg need to first lower their blood pressure to meet the standard. Patients with grade 3 hypertension (≥ 180/110mmHg) are prohibited from using it until their blood pressure stabilizes at<140/90mmHg for at least one week.

(1) Selection of voltage reduction plan

Prioritize the use of ACEI/ARB antihypertensive drugs and avoid the combination of potent CYP3A4 inhibitors. During the treatment period, blood pressure should be monitored weekly, and if a hypertensive crisis occurs, medication should be permanently discontinued.

(2) Risk population management

The elderly, diabetes or chronic kidney disease patients need more strict pressure control (<130/80mmHg). When the systolic blood pressure fluctuation is greater than 20mmHg, consideration should be given to reducing or suspending medication.

3. Alternative treatment recommendations

Patients with contraindications may consider second-generation TKIs (such as dasatinib) or immunotherapy. Alternative options need to be selected based on genetic testing results, and cardiovascular risk needs to be reassessed.