Background and importance Venous thromboembolic disease is a frequent and important complication in haematologic patients and is associated with a worse prognosis. Thromboembolism prophylaxis (TP) is recommended in patients with multiple myeloma (MM) and treated with immunomodulators.
Aim and objectives To assess the adequacy of TP in patients with MM at treatment onset with thalidomide and lenalidomide according to thromboembolic risk.
Material and methods Descriptive retrospective study was conducted (January 2016–January 2021) including patients with MM in treatment with thalidomide or lenalidomide. Farmatools application and electronic medical history were used to record: sex, age, MM treatment and duration, risk factors at MM treatment onset, thromboprophylactic drug and prophylactic doses.
Khorana scale was used as a predictive model to assess thromboembolic risk. This scale uses the variables: location of involvement, platelet and leukocyte levels, treatment with erythropoiesis stimulants or low haemoglobin and body mass index. Depending on the value obtained, the patient is classified as: low risk (LR, score=0), intermediate (IR, 1–2) and high risk (HR, ≥3). The recommended TP for scores ≤1 is low-dose acetylsalicylic acid (ASA) or low molecular weight heparin (LMWH) at prophylactic doses, and for scores ≥2 it is LMWH as prophylactic.
Results Forty patients (68% female) with a median age of 73 (range 52–87) years were included. The median duration of MM treatment was 8.1 (0.7–40) months. Two patients (5%) presented LR, both with lenalidomide and received appropriated TP with LMWH.
Thirty-three patients (83%) presented IR: 14 (35%) in treatment with lenalidomide, 6 (15%) thalidomide and 13 (33%) with both treatments. TP treatment was low-dose ASA in 2 (5%) patients and LMWH in 29 (73%). Three patients (7%) with IR received LMWH doses higher than prophylactic and two patients (5%) did not receive TP.
Two patients (5%) presented HR, both with lenalidomide and received appropriated TP with LMWH.
No data were found in 3 patients (7%).
Conclusion and relevance TP was in accordance with recommendations in most of the patients with MM treated with oral immunomodulators. A few patients did not receive adequate TP. Almost all the patients presented intermediate thromboembolic risk at MM treatment onset.
Conflict of interest No conflict of interest
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