Abstract Number: PB2098
Meeting: ISTH 2020 Congress
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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