Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores
Background: The high risk of venous thromboembolism (VTE) in multiple myeloma (MM) warrants primary thromboprophylaxis for most patients. Myeloma-specific thrombotic risk scores (TRSs), such as IMPEDE-VTE, SAVED, and PRISM, were developed to improve risk assessment and guide antithrombotic strategie...
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Elsevier
2024-10-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037924002668 |
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| author | Omar Eduardo Fernandez-Vargas Isabel Amezcua Beatriz Cabello Andrea Quintana Martinez Ramiro Espinoza Gabriela Cesarman-Maus |
| author_facet | Omar Eduardo Fernandez-Vargas Isabel Amezcua Beatriz Cabello Andrea Quintana Martinez Ramiro Espinoza Gabriela Cesarman-Maus |
| author_sort | Omar Eduardo Fernandez-Vargas |
| collection | DOAJ |
| description | Background: The high risk of venous thromboembolism (VTE) in multiple myeloma (MM) warrants primary thromboprophylaxis for most patients. Myeloma-specific thrombotic risk scores (TRSs), such as IMPEDE-VTE, SAVED, and PRISM, were developed to improve risk assessment and guide antithrombotic strategies. Their performance is variable and has not yet been tested in Latin America. Objectives: We aimed to assess the use of primary thromboprophylaxis, the incidence of VTE and bleeding events, and the effectiveness of TRSs in patients with newly diagnosed MM. Methods: This was a retrospective, single-center study. Cumulative VTE rates and TRS performance were analyzed using survival and receiver operating characteristic curves. Results: The study included 250 newly diagnosed MM patients; the vast majority (98.6%) received aspirin as thromboprophylaxis. VTE occurred in 8% within the initial 6 months, increasing to 14.8% over a median follow-up of 19 months. High rates of major bleeding (4.8%) and clinically relevant nonmajor bleeding (4.4%) events were documented. A minimal proportion (0.8%, 0.5%, and 1.2%) of patients were classified as low risk by IMPEDE-VTE, PRISM, and SAVED scores, respectively. Only IMPEDE-VTE exhibited a trend for distinguishing between intermediate-risk (7.14%) and high-risk (13.2%) groups (P = .09). PRISM and SAVED scores showed limited utility. VTE did not impact survival. Conclusion: Aspirin as primary thromboprophylaxis carries an unacceptable risk of VTE and bleeding in patients at intermediate or high thrombotic risk. The IMPEDE-VTE score performed best, although without reaching statistical significance. We confirm that VTE does not portend poor overall survival in MM. |
| format | Article |
| id | doaj-art-7da13d3ed32948e081b4f2f23b0e028c |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-7da13d3ed32948e081b4f2f23b0e028c2024-11-23T06:31:20ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792024-10-0187102571Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scoresOmar Eduardo Fernandez-Vargas0Isabel Amezcua1Beatriz Cabello2Andrea Quintana Martinez3Ramiro Espinoza4Gabriela Cesarman-Maus5Department of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoDepartment of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoDepartment of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoDepartment of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoDepartment of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoCorrespondence Gabriela Cesarman-Maus, Hematology Department, Instituto Nacional de Cancerología, San Frenando 22, Tlalpan, Mexico City, CDMX 14080, Mexico.; Department of Hematology, Instituto Nacional de Cancerología, Mexico City, MexicoBackground: The high risk of venous thromboembolism (VTE) in multiple myeloma (MM) warrants primary thromboprophylaxis for most patients. Myeloma-specific thrombotic risk scores (TRSs), such as IMPEDE-VTE, SAVED, and PRISM, were developed to improve risk assessment and guide antithrombotic strategies. Their performance is variable and has not yet been tested in Latin America. Objectives: We aimed to assess the use of primary thromboprophylaxis, the incidence of VTE and bleeding events, and the effectiveness of TRSs in patients with newly diagnosed MM. Methods: This was a retrospective, single-center study. Cumulative VTE rates and TRS performance were analyzed using survival and receiver operating characteristic curves. Results: The study included 250 newly diagnosed MM patients; the vast majority (98.6%) received aspirin as thromboprophylaxis. VTE occurred in 8% within the initial 6 months, increasing to 14.8% over a median follow-up of 19 months. High rates of major bleeding (4.8%) and clinically relevant nonmajor bleeding (4.4%) events were documented. A minimal proportion (0.8%, 0.5%, and 1.2%) of patients were classified as low risk by IMPEDE-VTE, PRISM, and SAVED scores, respectively. Only IMPEDE-VTE exhibited a trend for distinguishing between intermediate-risk (7.14%) and high-risk (13.2%) groups (P = .09). PRISM and SAVED scores showed limited utility. VTE did not impact survival. Conclusion: Aspirin as primary thromboprophylaxis carries an unacceptable risk of VTE and bleeding in patients at intermediate or high thrombotic risk. The IMPEDE-VTE score performed best, although without reaching statistical significance. We confirm that VTE does not portend poor overall survival in MM.http://www.sciencedirect.com/science/article/pii/S2475037924002668aspirinmultiple myelomaprophylaxisrisk factorsvenous thromboembolism |
| spellingShingle | Omar Eduardo Fernandez-Vargas Isabel Amezcua Beatriz Cabello Andrea Quintana Martinez Ramiro Espinoza Gabriela Cesarman-Maus Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores Research and Practice in Thrombosis and Haemostasis aspirin multiple myeloma prophylaxis risk factors venous thromboembolism |
| title | Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores |
| title_full | Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores |
| title_fullStr | Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores |
| title_full_unstemmed | Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores |
| title_short | Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores |
| title_sort | multiple myeloma retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores |
| topic | aspirin multiple myeloma prophylaxis risk factors venous thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2475037924002668 |
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