Approach to Contemporary Risk Assessment, Prevention and Management of Thrombotic Complications in Multiple Myeloma

Simple Summary There is a significant risk of thrombotic complications in patients with multiple myeloma. Patient-related, disease-related, and treatment-related risk factors contribute to the observed prothrombotic environment. The prevention of thrombosis requires implementing risk assessment tools and pharmacological thromboprophylaxis. Newer oral anticoagulants are increasingly being used in this setting, but robust data emerging from controlled clinical trials are lacking. Despite the use of multiple myeloma-specific risk-assessment tools and the implementation of thromboprophylaxis based on current guidelines, the risk of thromboembolism remains significant, pointing to the need to understand this common complication further. Multiple myeloma (MM) is associated with an increased risk of thrombotic complications, which remains substantial despite the implementation of thromboprophylaxis. The procoagulant state that characterizes the disease is multifactorial, and a greater understanding of the underlying pathophysiology is required to inform appropriate thrombosis prevention. Currently, there is a shift towards using direct oral anticoagulants (DOACs) in this setting; head-to-head comparisons in the context of controlled clinical trials between class agents are still missing. MM-specific VTE risk assessment scores have been developed to optimize management and minimize the associated mortality/morbidity. Their clinical utility remains to be evaluated. The value of adding biomarkers to clinical scores to optimize their performance and increase their discriminatory power is also under assessment.

Automated summary

Patients with multiple myeloma have a significant risk of thrombotic complications, which require risk assessment tools and pharmacological prophylaxis. The use of newer oral anticoagulants is increasing, but data from controlled clinical trials are lacking.