Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

Other thrombotic conditionsDVT riskfactorsIndividual andmyeloma-relatedfactorsMyelomatherapyDVT risk scoring in patients with myeloma treatedwith thalidomide or lenalidomideCategoryProphylaxis• BMI ≥ 30 kg/m 2• Previous DVT or PTE• Central venous catheter or pacemaker• Concomitant disease (cardiac, chronicrenal, diabetes, acute infection,immobilization)• Medications (EPO)• Clotting disorders• HyperviscosityHigh dose of dexamethasone,doxorubicin, polychemotherapy≤ 1 risk factor:• Aspirin(80-300 mg/d)≥ 2 factors:• LMWH (equivalentto enoxaparin40 mg/d) or• VKA (INR = 2-3)HBPM (e.g., enoxaparin40 mg/d) or VKA(INR = 2-3)BMI: Body Mass Index; EPO: Erythropoietin; LMWH: Low-Molecular-Weight Heparin; INR: InternationalNormalized Ratio; VKA: Vitamin K antagnonistsInterpretationThe risk of thrombosis is high in patients with multiple myeloma, especially in thosereceiving thalidomide or lenalidomide combined with dexamethasone. In thesepatients antithrombotic prophylaxis should be considered, according to the risk.References• Ay C, Dunkler D, Marosi C, et al. Prediction of venous thromboembolism in cancerpatients. Blood. 2010;116:5377-82.• Farge D, Debourdeau P, Beckers M, et al. International clinical practice guidelines forthe treatment and prophylaxis of venous thromboembolism in patients with cancer.J Thromb Haemost. 2013;11:56-70.• Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictivemodel for chemotherapy-associated thrombosis. Blood. 2008;111:4902-7.• Louzada ML, Carrier M, Lazo-Langner A, et al. Development of a clinical prediction rulefor risk stratification of recurrent venous thromboembolism in patients with cancer:Associated Venous Thromboembolism. Circulation. 2012;126:448-54.• Palumbo A, Rajkumar SV, Dimopoulos MA, et al.; International Myeloma WorkingGroup. Prevention of thalidomide- and lenalidomide-associated thrombosis inmyeloma. Leukemia. 2008;22:414-23.34