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. 2024 Sep 12;8(7):102571.
doi: 10.1016/j.rpth.2024.102571. eCollection 2024 Oct.

Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores

Omar Eduardo Fernandez-Vargas  1 , Isabel Amezcua  1 , Beatriz Cabello  1 , Andrea Quintana Martinez  1 , Ramiro Espinoza  1 , Gabriela Cesarman-Maus  1
Affiliations

Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores

Omar Eduardo Fernandez-Vargas et al. Res Pract Thromb Haemost. .

Abstract

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.

Keywords: aspirin; multiple myeloma; prophylaxis; risk factors; venous thromboembolism.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Cumulative incidence of venous thromboembolism (VTE) by thrombotic risk score (TRS) risk stratification. Kaplan–Meier curves for 6-month cumulative VTE for IMPEDE-VTE (A), SAVED (B), and 12 months cumulative VTE for PRISM (C).
Figure 2
Figure 2
Thrombotic risk score performance evaluation. Sensitivity and specificity were determined using receiver operating characteristic curve analysis at 6 months for the 3 scores being evaluated. Briefly, scales were transformed into a series of binary classification problems, with the area under the curve employed as a measure of overall thrombotic risk score performance.
Figure 3
Figure 3
Overall survival and impact of venous thromboembolism (VTE) events. Overall survival as determined by the Kaplan–Meier method for patients with (red) and without VTE (blue).
Supplementary Figure S1
Supplementary Figure S1
Cumulative VTE incidence by TRS score. Cumulative incidence of VTE over different time frames, based on points scored by each validated TRS: (A) IMPEDE-VTE for 6 months, (B) SAVED for 6 months, and (C) PRISM for 12 months.
See this image and copyright information in PMC

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