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Use of Direct Oral Anticoagulants (DOACs) as Primary or Secondary Prophylaxis of Venous Thromboembolism in Patients with Multiple Myeloma on Immunomodulatory Drugs

C. Aguilar, A.B. Dueñas, F. Sevil, C. Domínguez

Hospital General Santa Bárbara, Haematology, Soria, Spain

Abstract Number: PB2098

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » Cancer Associated Thrombosis

Background: Recent reports support the potential role of DOACs for venous thromboembolism (VTE) prophylaxis in patients with multiple myeloma (MM) on any immunomodulatory agent (IMA).

Aims: To evaluate efficacy and safety of DOACs as thromboprofylactic agents in MM patients treated with some IM.

Methods: Between July 2018 and January 2020 all our patients diagnosed with MM and receiving some IMA-containing scheme were proposed to start VTE prophylaxis with a DOAC.

Results: Fourteen MM patients fulfilling mentioned criteria accepted to receive a DOAC. Median age was 67 years (range 53-86). Patients were receiving 1st (7 cases), 2nd (2 cases), 3rd line
(1 case) or maintenance therapy following autologous stem cell transplantation (lenalidomide 2 cases; ixazomib-lenamidomide-dexamethasone 2 cases). All but one (on a pomalidomide-containing regimen) were receiving a lenalidomide-containing regimen (Rd- 5 cases; VRD 4 cases; lenalidomide or IRd maintenance 4 cases). Median duration of treatment was 339 days (range 23-526). Rivaroxaban (20 mg od; 5 cases) was the most commonly prescribed DOAC in patients with a prior history of VTE (edoxaban 60 mg; 1 case) whereas apixaban (2.5 mg bd) was prescribed off-label for primary VTE prophylaxis purposes (7 patients). One individual was receiving rivaroxaban due to non valvular atrial fibrillation when anti-MM treatment was started; in other 2 cases a DOAC replaced acenocumarol. No patient developed any VTE event. Two minor bleeding events (rectorrhagia, epistaxis) and no major or clinically relevant non-major bleeds were reported. Five subjects had stopped DOAC treatment at the end of the follow-up period due to death or lenalidomide discontinuation (median treatment duration 112 days; range 23-292).

Conclusions: Use of DOACs as a primary or secondary VTE prophylaxis in MM patients on IMA may be regarded as a useful and safe therapeutic tool to be considered in such cases.

To cite this abstract in AMA style:

Aguilar C, Dueñas AB, Sevil F, Domínguez C. Use of Direct Oral Anticoagulants (DOACs) as Primary or Secondary Prophylaxis of Venous Thromboembolism in Patients with Multiple Myeloma on Immunomodulatory Drugs [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/use-of-direct-oral-anticoagulants-doacs-as-primary-or-secondary-prophylaxis-of-venous-thromboembolism-in-patients-with-multiple-myeloma-on-immunomodulatory-drugs/. Accessed October 1, 2023.

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