Approach to Contemporary Risk Assessment, Prevention and Management of Thrombotic Complications in Multiple Myeloma
Despina Fotiou1, Meletios Athanasios Dimopoulos1, Efstathios Kastritis1
1Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Abstract:
Multiple myeloma (MM) is associated with an increased risk of thrombotic complications, which remains substantial despite the implementation of thromboprophylaxis. The procoagulant state that characterizes the disease is multifactorial, and a greater understanding of the underlying pathophysiology is required to inform appropriate thrombosis prevention. Currently, there is a shift towards using direct oral anticoagulants (DOACs) in this setting; head-to-head comparisons in the context of controlled clinical trials between class agents are still missing. MM-specific VTE risk assessment scores have been developed to optimize management and minimize the associated mortality/morbidity. Their clinical utility remains to be evaluated. The value of adding biomarkers to clinical scores to optimize their performance and increase their discriminatory power is also under assessment.
Insights
Multiple myeloma patients face high thrombosis risk. Understanding disease pathophysiology and optimizing risk assessment scores with biomarkers are key for better prevention strategies.
Area of Science:
- Hematology
- Oncology
- Thrombosis Research
Background:
- Multiple myeloma (MM) significantly elevates thrombotic complication risk, even with prophylaxis.
- The procoagulant state in MM is complex, necessitating deeper pathophysiological understanding for effective thrombosis prevention.
- Current anticoagulation strategies are evolving, with a trend towards direct oral anticoagulants (DOACs), but comparative trials are lacking.
Purpose of the Study:
- To review the current understanding of thrombosis risk in multiple myeloma.
- To discuss the evolving role of direct oral anticoagulants (DOACs) in MM-related thrombosis.
- To evaluate the utility of MM-specific venous thromboembolism (VTE) risk assessment scores and potential biomarker integration.
Main Methods:
- Literature review of pathophysiology and clinical trials.
- Analysis of current anticoagulation practices in MM.
- Assessment of risk stratification tools and biomarkers for VTE in MM.
Main Results:
- Thrombosis remains a significant challenge in MM despite prophylaxis.
- Direct oral anticoagulants (DOACs) are increasingly used, but head-to-head trial data is absent.
- MM-specific VTE risk scores exist, but their clinical utility and the value of biomarkers require further evaluation.
Conclusions:
- Improved understanding of MM pathophysiology is crucial for advanced thrombosis prevention.
- Further research is needed to compare DOACs and validate risk assessment tools, including biomarker integration, for optimal VTE management in MM.
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