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Bleeding risk in patients with multiple myeloma treated for venous thromboembolism: a MarketScan analysis

Diego Adrianzen-Herrera1, Pamela L Lutsey2, Katherine Giorgio2

  • 1Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.

Research and Practice in Thrombosis and Haemostasis
|March 6, 2023
PubMed
Abstract

Insights

Patients with multiple myeloma on anticoagulation face bleeding risks comparable to other cancer patients. Factors like age, comorbidities, and certain medications increase this risk, with newer anticoagulants showing lower bleeding rates than warfarin.

Area of Science:

  • Hematology
  • Oncology
  • Pharmacology

Background:

  • Multiple myeloma (MM) significantly increases the risk of venous thromboembolism (VTE).
  • While thromboprophylaxis in MM is well-researched, data on bleeding risk in MM patients receiving anticoagulation is scarce.
  • This study addresses the gap in understanding bleeding complications in MM patients on anticoagulant therapy.

Purpose of the Study:

  • To assess the incidence of serious bleeding events in multiple myeloma patients treated with anticoagulation for VTE.
  • To identify clinical factors associated with an increased risk of bleeding in this patient population.

Main Methods:

  • A real-world analysis using the MarketScan commercial database (2011-2019).
  • Identified 1298 patients with MM receiving anticoagulation for incident VTE.
  • Utilized the Cunningham algorithm for hospitalized bleeding identification and Cox regression for risk factor analysis.

Main Results:

  • A total of 51 (3.9%) patients experienced bleeding during a median follow-up of 1.13 years, equating to a rate of 24.0 per 1000 person-years.
  • Increased bleeding risk was associated with higher age, Charlson comorbidity index, concurrent antiplatelet use, diabetes, and renal disease.
  • Cumulative bleeding incidence was 4.7% for warfarin, 3.2% for low molecular weight heparin (LMWH), and 3.4% for direct oral anticoagulants (DOACs).

Conclusions:

  • The bleeding rate in multiple myeloma patients on anticoagulation is comparable to other cancer-related VTE cohorts.
  • LMWH and DOACs demonstrated lower bleeding rates compared to warfarin.
  • Elevated comorbidity index, diabetes, antiplatelet use, and renal disease are significant risk factors for serious bleeding in MM patients requiring anticoagulation.
Keywords:
anticoagulantshemorrhagemultiple myelomarisk factorsvenous thromboembolism

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