Dede Ruth J, Pruemer Jane M
Department of Pharmacy Services, UC Health-University of Cincinnati Medical Center, Cincinnati, USA
James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, USA.
J Oncol Pharm Pract. 2016 Apr;22(2):248-55. doi: 10.1177/1078155215569555. Epub 2015 Jan 27.
Patients with multiple myeloma have an increased incidence of venous thromboembolism. The risk for venous thromboembolism further increases when these patients are placed on immunomodulatory drug therapy. This study aims to determine the incidence of venous thromboembolism in patients with multiple myeloma receiving immunomodulatory drug therapy in the ambulatory setting at UC Health and to investigate adherence with guidelines developed by The National Comprehensive Cancer Network for venous thromboembolism prevention in this patient population.
A retrospective chart review of patients with multiple myeloma initiated on immunomodulatory drug therapy between January 2000 and January 2014 was conducted.
Sixty-two cases met inclusion criteria and were included for analysis. The National Comprehensive Cancer Network guidelines were followed in 33.9% of cases. The rate of venous thromboembolism was 4.8% in guideline adherent cases and 12.2% in guideline nonadherent cases (p = 0.65). The overall incidence of venous thromboembolism was 9.7%. No patients on a low-molecular-weight-heparin agent or warfarin developed a venous thromboembolism, 7.9% patients on aspirin therapy developed a venous thromboembolism, and 23.1% patients on no pharmacologic thromboprophylaxis developed a venous thromboembolism (p = 0.26).
Ambulatory patients with multiple myeloma who are considered for immunomodulatory drug therapy should be placed on pharmacologic thromboprophylaxis based on individual venous thromboembolism and bleeding risk factors. This study identified the need for increased adherence to national guidelines for venous thromboembolism prevention in patients with multiple myeloma receiving immunomodulatory drug therapy so as to increase the quality of care provided at UC Health.
多发性骨髓瘤患者静脉血栓栓塞的发生率增加。当这些患者接受免疫调节药物治疗时，静脉血栓栓塞的风险会进一步增加。本研究旨在确定在加州大学健康系统门诊接受免疫调节药物治疗的多发性骨髓瘤患者中静脉血栓栓塞的发生率，并调查该患者群体对美国国立综合癌症网络制定的静脉血栓栓塞预防指南的遵循情况。
对2000年1月至2014年1月开始接受免疫调节药物治疗的多发性骨髓瘤患者进行回顾性病历审查。
62例符合纳入标准并纳入分析。33.9%的病例遵循了美国国立综合癌症网络指南。遵循指南的病例中静脉血栓栓塞发生率为4.8%，未遵循指南的病例中为12.2%（p = 0.65）。静脉血栓栓塞的总体发生率为9.7%。接受低分子量肝素或华法林治疗的患者未发生静脉血栓栓塞，接受阿司匹林治疗的患者中有7.9%发生静脉血栓栓塞，未进行药物性血栓预防的患者中有23.1%发生静脉血栓栓塞（p = 0.26）。
考虑接受免疫调节药物治疗的门诊多发性骨髓瘤患者应根据个体静脉血栓栓塞和出血风险因素进行药物性血栓预防。本研究确定了在接受免疫调节药物治疗的多发性骨髓瘤患者中需要提高对国家静脉血栓栓塞预防指南的遵循率，以提高加州大学健康系统提供的护理质量。
