Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan.
J Thromb Thrombolysis. 2019 Jul;48(1):141-148. doi: 10.1007/s11239-019-01809-w.
Anti-platelet agents or anticoagulants are administered for patients with multiple myeloma (MM) receiving immunomodulatory drugs (IMiDs) to prevent thrombotic events (TEs). However, there is a discrepancy between current guidelines and clinical practice in thromboprophylaxis and the varied incidence of TEs depending on patient cohort. Therefore, a consensus on the optimal thromboprophylactic strategy is needed. To determine an appropriate strategy for the prevention of TEs in MM patients receiving IMiDs, we performed a retrospective single-institution analysis. In total, 95 MM patients (62% male, median age 65 years, range 30-85 years) from November 2008 to January 2018 were recruited, and 140 cases were analyzed in the medical-record-based study. Thromboprophylactic drugs were given to 69% of patients, anti-platelet agents to 66%, and anticoagulants to 3.0%. Seven TEs (5.0%) and six bleeding events (4.3%) were observed, but no patients died from thrombohemorrhage. The median follow-up period was 184 days (range 21-2224), and the cumulative TE incidence was 1.7% at 3 months, 7.0% at 1 year, and 12.5% at 3 years. Multivariate analysis determined that age > 70 years (p = 0.012) and BMI < 18.5 kg/m (p = 0.042) were the significant risk factors of TE. A low incidence of TEs was observed despite the low adherence to guideline recommendations for anticoagulant administration. These results suggest that anti-platelet agents are sufficient for thromboprophylaxis. A high-risk group of TEs in MM patients receiving IMiDs was identified, and a larger study is needed to confirm these findings.
抗血小板药物或抗凝剂用于接受免疫调节药物 (IMiDs) 的多发性骨髓瘤 (MM) 患者，以预防血栓事件 (TEs)。然而，目前的指南与临床实践在血栓预防方面存在差异，并且根据患者队列的不同，TEs 的发生率也不同。因此，需要就最佳的血栓预防策略达成共识。为了确定接受 IMiDs 的 MM 患者预防 TEs 的适当策略，我们进行了一项回顾性单机构分析。总共招募了 95 名 MM 患者（62%为男性，中位年龄 65 岁，范围为 30-85 岁），并在病历基础研究中分析了 140 例。69%的患者使用了抗血小板药物，66%的患者使用了抗血小板药物，3.0%的患者使用了抗凝药物。观察到 7 例 TEs（5.0%）和 6 例出血事件（4.3%），但没有患者因血栓性出血而死亡。中位随访时间为 184 天（范围为 21-2224），3 个月时 TEs 的累积发生率为 1.7%，1 年时为 7.0%，3 年时为 12.5%。多变量分析确定年龄>70 岁（p=0.012）和 BMI<18.5 kg/m（p=0.042）是 TE 的显著危险因素。尽管抗凝药物的使用指南推荐的依从性较低，但观察到 TEs 的发生率较低。这些结果表明抗血小板药物足以进行血栓预防。确定了接受 IMiDs 的 MM 患者 TE 的高危人群，需要进行更大规模的研究来证实这些发现。
