Study Finds Gap in Guideline-Directed VTE Prophylaxis in IMiD Therapy for Multiple Myeloma

A retrospective study of patients with multiple myeloma receiving immunomodulator (IMiD) therapy found variable use of guideline-recommended venous thromboembolism (VTE) prophylaxis. The study was presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024.

In total, 210 patients were included, of whom 63 received appropriate VTE prophylaxis. The IMPEDE VTE prediction scores were significantly associated with administration of prophylaxis (P=.009). In the group that received prophylaxis, 92.1% had an IMPEDE score ≥8, denoting high risk of VTE. In the no prophylaxis group, 79.6% had an IMPEDE score ≥8.

VTE history was also associated with prophylaxis. The odds ratio (OR) for receiving prophylaxis in patients with a VTE history was 55 (95% CI, 19.8-153.2; P<.001). Those with a VTE history had significantly higher IMPEDE scores, with an average of 14.5 compared with an average of 8.7 in patients without a VTE history.

Patients with a history of atrial fibrillation also had greater odds of receiving prophylaxis (OR, 22.1; 95% CI, 6.3-77.3; P<.001). Obesity, type of IMiD therapy, and administration of an induction regimen were not significantly associated with likelihood of receiving VTE prophylaxis.

In patients with an IMPEDE score ≥4 (moderate to high risk of VTE), the most common form of prophylaxis was aspirin 81 mg (52% of patients with IMPEDE 4-7 and 58% of patients with IMPEDE ≥8). Twenty-three percent of patients with an IMPEDE score of 4 to 7 did not receive any prophylaxis.

“Despite high IMPEDE scores indicating elevated VTE risk, most patients were only prescribed aspirin 81 mg for prophylaxis, revealing a gap between recommended prophylaxis and clinic practice,” the authors wrote. This finding “underscores the need for improved adherence to evidence-based guidelines and risk assessment tools in guiding VTE prophylaxis decisions, especially in patients with elevated risk.”

Reference

Van A, Sezate G, De Padova N. Characterization of VTE prophylaxis in multiple myeloma patients receiving immunomodulator (IMiD) therapy. Poster. Presented at the Hematology/Oncology Pharmacy Association Annual Conference 2024; April 3-6, 2024; Tampa, Florida.