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Thromboprophylaxis with LMWH, warfarin, low-dose aspirin, safe in newly diagnosed multiple myeloma

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51st ASH Annual Meeting

Despite the recommendation for anticoagulant prophylaxis in people with newly diagnosed multiple myeloma, controversies exist over the best thromboprophylactic regimen to adopt. Today, at the 51st ASH Annual Meeting, an investigator of the Italian Multiple Myeloma Network presented data indicating that the use of thromboprophylaxis with low-molecular weight heparin, warfarin or low-dose aspirin were all equally safe and effective to prevent venous thromboembolism in this patient group.

This study of thromboprophylaxis was a substudy of the GIMEMA study. In GIMEMA, 991 patients with newly diagnosed multiple myeloma were randomly assigned to:

• Bortozemib (Velcade, Millenium) 1.3 mg/m²; thalidomide 200 mg; and dexamethasone 320 mg for (VTD).
• Thalidomide 200 mg and dexamethasone 320 mg (TD).
• Bortezomib 1.3 mg/m²; melphalan 9 mg/m²; prednisone 60 mg/m²; thalidomide 50 mg (VMPT).
• Bortezomib 1.3 mg/m²; melphalan 9 mg/m² and prednisone 60 mg/m² (VMP).

In the substudy, researchers randomly assigned patients treated with VTD, TD or VMPT to LMWH (enoxaparin 40 mg daily; n=223), aspirin 100 mg daily (n=227) or warfarin 1.25 mg daily (n=223) during induction therapy. Sixty-one patients were excluded due to high-risk for bleeding. Patients treated with VMP (n=257) were treated as controls.

Endpoints were incidence for VTE, acute cardiovascular events, sudden death, major and minor bleeding.

VTE incidence

VTE incidence was 2% in the VMP group, 5% in the LMWH group, 6% in the aspirin group and 8% in the warfarin group.

Median time to onset of VTE was 4.7 months for patients assigned LMWH, and 2.4 months for patients assigned both aspirin and warfarin.

Rates for cardiovascular events were 2% in the LMWH group, 1% in the aspirin group and 0.5% in the warfarin group. The incidence for major and minor bleeding was 3% in the aspirin group, 2% in the LMWH group and 1% in the warfarin group. The incidence for combined thrombosis, bleeding and cardiovascular events was 9% in both the LMWH group and warfarin group and 10% in the aspirin group. - by Jennifer Southall

For more information:

• Palumbo A. #492. Presented at: 51st ASH Annual Meeting and Exposition; Dec. 5-8, 2009; New Orleans.

More ASH Meeting Highlights>>