Prophylactic anticoagulants, pharmacy oversight lower VTE risk in multiple myeloma

Treatment with a guideline-based thromboprophylaxis in multiple myeloma patients and the addition of pharmacy oversight to risk assessment can help reduce the risk of venous thromboembolism (VTE), suggests a recent study.

“Immunomodulatory drugs used to treat multiple myeloma carry an increased risk of VTE disease,” the investigators said. “Previously published guidelines outline consensus opinion on how to mitigate this risk.”

In this study, baseline data were obtained to analyse how these strategies were utilized at a single institution. The investigators then aimed to improve the rates of anticoagulation for patients at high risk for VTE. This was done through a quality improvement project that included pharmacy or haematology oversight to the VTE risk assessment.

Thirty-nine patients newly initiated on immunomodulatory therapy were examined for VTE risk. This information was shared with the myeloma provider for consideration.

Of the patients, 22 were classified as high risk for VTE. Among those at high risk, 14 (64 percent) were treated with an anticoagulant for thromboprophylaxis. Eleven of the 14 patients received direct oral anticoagulants (DOACs).

Eight high-risk patients were not treated with an anticoagulant for thromboprophylaxis; of these, four developed VTE. None of the patients on anticoagulation developed a VTE. Furthermore, such strategy resulted in rare minor bleeding complications.

“This quality action verifies guideline-based thromboprophylaxis in multiple myeloma and supports the benefit of pharmacy oversight in improving VTE rates,” the investigators said. “The use of DOACs in myeloma should be further explored.”