Thromboprophylaxis in multiple myeloma: a case-based review with practical guidelines

Area of Science:

• Hematology
• Oncology
• Clinical Medicine

Background:

• Venous thromboembolism (VTE) is a significant complication in multiple myeloma (MM) patients.
• VTE incidence ranges up to 10% in newly diagnosed MM and varies in relapsed/refractory settings.
• Effective VTE risk assessment and personalized thromboprophylaxis are crucial for supportive care in MM.

Purpose of the Study:

• To review the practical application of VTE risk prediction models in current multiple myeloma therapies.
• To emphasize the necessity of a tailored approach integrating patient-specific, disease-specific, and treatment-specific factors.
• To summarize VTE prophylaxis data and highlight situations favoring direct oral anticoagulants in MM.

Main Methods:

• Review of current literature on VTE risk assessment models (SAVED, IMPEDE-VTE, PRISM) in multiple myeloma.
• Analysis of patient-specific, disease-specific, and treatment-specific risk factors.
• Summary of available data on VTE thromboprophylaxis strategies, including direct oral anticoagulants.

Main Results:

• Three validated VTE risk assessment models exist for newly diagnosed multiple myeloma.
• A tailored approach combining model outputs with individual patient factors is essential.
• Direct oral anticoagulants are indicated in specific clinical scenarios for VTE prophylaxis.

Conclusions:

• Accurate VTE risk stratification and personalized prophylaxis are vital in multiple myeloma management.
• Integrating risk models with clinical judgment ensures optimal supportive care.
• Further research and clinical guidance are needed to address VTE prophylaxis gaps in MM.