Prophylaxis and treatment of venous thromboembolism in patients with multiple myeloma

The incidence of venous thromboembolism (VTE) is markedly increased in patients with multiple myeloma (MM); furthermore, the risk

of VTE is increased during the induction phase of therapy, especially if a combination of thalidomide or lenalidomide with high dose

dexamethasone or prednisone is used, while therapy containing bortezomib is not associated with risk of thrombotic complications. The

effectiveness of pharmacological thromboprophylaxis using low-molecular-weight heparin (LMWH), acetylsalicylic acid (ASA) or warfarin

has been demonstrated in numerous non-randomized comparative studies, and the results of one randomized trial are recently available.

Pharmacological thromboprophylaxis is recommended in patients with MM during the induction therapy containing thalidomide or

lenalidomide combined with corticosteroids and/or anthracyclines. LMWH is the preferred mode of thromboprophylaxis in most patients;

warfarin should be used in patients with mechanical heart valve. ASA is considered as a reasonable alternative, especially for patients

with another indication of antiplatelet therapy. The optimal therapy of VTE in patients with MM is not well established; however, the

same approach as in other patients suffering from malignancy seems to be suitable. These patients should be treated with LMWH for the

first 6 months. The initial therapeutic dose can be reduced to 2/3–3/4 after one month. The therapy should be reevaluated after 6 month

and subsequent long-term therapy using LMWH or warfarin should be considered, unless complete remission of myeloma is reached.

Keywords: multiple myeloma, venous thromboembolism, thromboprophylaxis, Low-molecular-weight heparin