Fernandez-Vargas Omar Eduardo, Amezcua Isabel, Cabello Beatriz, Quintana Martinez Andrea, Espinoza Ramiro, Cesarman-Maus Gabriela
Department of Hematology, Instituto Nacional de Cancerología, Mexico City, Mexico.
Res Pract Thromb Haemost. 2024 Sep 12;8(7):102571. doi: 10.1016/j.rpth.2024.102571. eCollection 2024 Oct.
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.
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.
This was a retrospective, single-center study. Cumulative VTE rates and TRS performance were analyzed using survival and receiver operating characteristic curves.
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 ( = .09). PRISM and SAVED scores showed limited utility. VTE did not impact survival.
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.
多发性骨髓瘤（MM）患者发生静脉血栓栓塞（VTE）的风险较高，这使得大多数患者需要进行一级血栓预防。为了改善风险评估并指导抗血栓策略，开发了如IMPEDE-VTE、SAVED和PRISM等骨髓瘤特异性血栓形成风险评分（TRS）。它们的表现各不相同，尚未在拉丁美洲进行测试。
我们旨在评估新诊断的MM患者一级血栓预防的使用情况、VTE和出血事件的发生率以及TRS的有效性。
这是一项回顾性单中心研究。使用生存曲线和受试者工作特征曲线分析累积VTE发生率和TRS表现。
该研究纳入了250例新诊断的MM患者；绝大多数（98.6%）接受阿司匹林作为血栓预防。在最初6个月内，8%的患者发生VTE，在中位随访19个月时增加到14.8%。记录到较高的大出血（4.8%）和临床相关非大出血（4.4%）事件发生率。分别有极小比例（0.8%、0.5%和1.2%）的患者被IMPEDE-VTE、PRISM和SAVED评分归类为低风险。只有IMPEDE-VTE在区分中风险（7.14%）和高风险（13.2%）组方面呈现出一种趋势（P = 0.09）。PRISM和SAVED评分的效用有限。VTE不影响生存。
对于中高血栓形成风险的患者，阿司匹林作为一级血栓预防存在不可接受的VTE和出血风险。IMPEDE-VTE评分表现最佳，尽管未达到统计学意义。我们证实VTE并不预示MM患者总体生存不良。
