Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools

Abstract

Thromboembolism in multiple myeloma (MM) patients remains a common complication that renders the optimization of our thromboprophylaxis practice necessary. This review aims to make clear the need for the development of more accurate risk assessment tools and means of thrombosis prevention. Current clinical practice is guided by available guidelines published by the IMWG in 2014, but the extent to which these are implemented is unclear. Recently, several groups developed clinical scores for thrombosis risk in MM in an attempt to improve risk stratification, but these have not been validated or used in clinical practice so far. Research in this field is increasingly focusing on understanding the unique coagulation profile of the MM patient, and data on potential biomarkers that accurately reflect hypercoagulability is emerging. Finally, promising evidence on the effectiveness of direct oral anticoagulants (DOACs) in the context of thrombosis prevention in MM patients is increasingly becoming available. The critical appraisal of the above research areas will establish the necessity of combining disease-specific clinical risk factors with coagulation biomarkers to allow more effective risk stratification that will eventually lead to the reduction of this significant complication. Results from ongoing clinical trials on the role of DOACs are much anticipated.

Keywords: direct oral anticoagulants; multiple myeloma; risk assessment models; thromboprophylaxis; venous thromboembolism.

Figure 1

Algorithm for VTE risk assessment and thromboprophylaxis based on Table 1 risk factors; BMI: body mass index, CVC: central venous catheter, LMWH: low molecular weight heparin, EPO: erythropoietin, DOAC: direct oral anticoagulants. * Aspirin, LMWH, or warfarin for other clinical indication prior to treatment initiation for MM.