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Updated: Jun 12, 2025
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
A systematic review of direct oral anticoagulants for thromboprophylaxis in multiple myeloma
Cătălina Codreanu1, Tessa Elling1, Nic J G M Veeger2,3
1Department of Haematology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
Abstract:
Multiple myeloma (MM) is associated with increased venous thromboembolism (VTE) risk. Current guidelines recommend aspirin or low-molecular-weight heparin for thromboprophylaxis depending on VTE risk. Nevertheless, VTE risks remain high: a recent meta-analysis reported an incidence of 6.2% during the entire MM course. Direct oral anticoagulants (DOACs) showed promising results in other malignancies. This systematic review provides an overview of evidence on DOAC thromboprophylaxis in MM. PubMed and Embase were searched up to November 21, 2023, for studies evaluating MM and DOAC thromboprophylaxis (PROSPERO: CRD42022376152). Two authors independently screened titles, abstracts, and texts, assessed bias using a modified version of the Newcastle Ottawa Scale and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach, and performed data extraction and analysis. Seven articles comprising 416 patients with DOAC thromboprophylaxis were included, primarily involving newly diagnosed patients with MM (56.3%) receiving lenalidomide-based regimens (69.1%). Overall Newcastle Ottawa Scale study quality was moderate. Four studies reported follow-up duration ranging from 90 days after induction to 7 months. VTE proportions ranged from 0% to 23.5%, with 4 studies reporting 0%. The proportions of minor, clinically relevant nonmajor, and major bleeding ranged from 0% to 18.2%, 0% to 7.7%, and 0% to 4.5%, respectively. Arterial thrombosis proportions ranged from 0% to 2.9%. Only 2 studies reported on mortality (2% and 7.1%). Overall Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was very low for all outcomes. Current evidence regarding routine DOACs in MM is insufficient, warranting further research to establish the DOAC thromboprophylaxis risk-to-benefit ratio in MM.
Insights
Direct oral anticoagulants (DOACs) show potential for preventing venous thromboembolism (VTE) in multiple myeloma (MM) patients. However, current evidence is limited, indicating insufficient data to establish the risk-benefit ratio for routine DOAC use in MM.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Multiple myeloma (MM) patients face a significantly elevated risk of venous thromboembolism (VTE).
- Current thromboprophylaxis guidelines for MM, including aspirin or low-molecular-weight heparin, result in persistent high VTE rates.
- Direct oral anticoagulants (DOACs) have demonstrated efficacy in other cancer types, prompting investigation into their use in MM.
Purpose of the Study:
- To systematically review existing evidence on the efficacy and safety of direct oral anticoagulants (DOACs) for thromboprophylaxis in multiple myeloma (MM) patients.
- To assess the incidence of VTE and bleeding events in MM patients receiving DOACs for VTE prevention.
- To evaluate the overall certainty of evidence regarding DOAC use in MM thromboprophylaxis.
Main Methods:
- A systematic literature search was conducted on PubMed and Embase up to November 21, 2023.
- Seven studies involving 416 patients treated with DOACs for thromboprophylaxis in MM were included.
- Study quality was assessed using the Newcastle Ottawa Scale, and evidence certainty was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Main Results:
- Included studies primarily focused on newly diagnosed MM patients (56.3%) on lenalidomide-based regimens (69.1%).
- Reported VTE incidence ranged from 0% to 23.5%, with four studies showing 0% VTE events.
- Bleeding event proportions varied, with major bleeding reported between 0% and 4.5%. The certainty of evidence for all outcomes was rated as very low.
Conclusions:
- Current evidence on the routine use of DOACs for thromboprophylaxis in multiple myeloma is insufficient.
- Further research is required to establish a clear risk-to-benefit profile for DOACs in this patient population.
- The low certainty of evidence necessitates cautious interpretation of findings and highlights the need for high-quality clinical trials.
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