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    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB0943 - Results of a clinical audit of intermediate dose low molecular weight heparin for thromboprophylaxis in newly diagnosed multiple myeloma patients

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Co-Author(s)

    • CC

      Catalina Codreanu

      Medical Student
      Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
      Groningen, Groningen, Netherlands

      • Co-Author(s)

    • SB

      Soerajja Bhoelan, MD

      MD, PhD student
      Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
      Groningen, Groningen, Netherlands

    • WP

      Wouter J. Plattel

      MD, PhD, Internist-haematologist
      Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
      Groningen, Groningen, Netherlands

    • WR

      Wilfried W. H. Roeloffzen

      MD, PhD, Internist-haematologist
      Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
      Groningen, Groningen, Netherlands

      • Presenting Author(s)

    • Karina Meijer, MD, PhD (she/her/hers)

      MD, PhD, Internist-haematologist, Professor
      Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
      Groningen, Groningen, Netherlands

    Background: Newly diagnosed multiple myeloma (NDMM) patients receiving immunomodulatory drugs (IMIDs) have high venous thromboembolism (VTE) risk. After observing a 15% incidence in patients treated in Northern Netherlands in 2006-2013, the local guideline was revised with more intensive prophylaxis for patients with VTE risk factors.

    Aims: To describe the effect of change of protocol, including intermediate dose low molecular weight heparin (iLMWH) on NDMM VTE incidence.

    Methods: A 1-year follow-up retrospective cohort study of NDMM patients receiving IMIDs between 01.01.2014-01.09.2021 was conducted. Follow-up started at diagnosis and ended at death, VTE, or at 1 year. Ethical approval was waived by the local committee (METc 2022/285). The local guideline recommends aspirin for NDMM patients receiving IMIDs without, and “nadroparin 5700 EH od” for patients with VTE risk factors.
    The cumulative VTE incidence with death as competing risk (95% confidence interval (CI)) was calculated for the entire cohort and stratified per more or as advised thromboprophylaxis and per insufficient or no thromboprophylaxis.

    Results: 72 patients were included, 29 (40.3%) received aspirin, 25 (34.7%) iLMWH, 5 (6.9%) none and 13 (18.1%) other. 1 (1.4%) patient died and 1 (1.4%) was lost to follow-up. 7 (9.7%) experienced VTE (incidence 9.8 (95% CI, 4.3, 18.1)) (figure 1). After excluding 4 patients with missing data for VTE risks, 27 (39.7%) had none and 41 (60.3%) had 1 or more. 47 (69.1%) patients received thromboprophylaxis as advised or more and had a 8.6 (95% CI, 2.7, 18.9) incidence. 21 (30.9%) patients received insufficient or no thromboprophylaxis and had a 14.3 (95% CI, 3.4, 32.6) incidence (figure 2).

    Conclusion(s): After implementing the higher dose LMWH, overall VTE incidence seems to have decreased, although still unacceptably high. Patients receiving thromboprophylaxis as advised or more appear to have a lower risk. Studies into novel strategies are needed, including Xa inhibitors.