Low molecular weight heparins for thromboprophylaxis during induction chemotherapy in patients with multiple myeloma
Abstrakt
Patients with multiple myeloma have a high risk of venous thromboembolism (VTE), especially during the induction chemotherapy. The aim of our observational study was to determine the impact of prophylaxis with low molecular weight heparin (LMWH) on the incidence of thromboembolic complications.
We analyzed the incidence of thromboembolic events in 258 patients treated with induction chemotherapy containing vincristin, doxorubicin, and dexamethasone, followed by stimulation chemotherapy with cyclophosphamide and G-CSF, and high-dose chemotherapy with melphalan. Two groups of these patients were compared based on the practice of thromboprophylaxis.
Patients in the first group were either not treated or treated with a short duration of anticoagulation therapy while the patients in the second group underwent standard prophylaxis with LMWH throughout the entire period of induction chemotherapy. A total of 102 patients were selected for a close monitoring of the prophylactic effect of different LMWH doses and to be compared to patients without treatment.
Standard prohpylaxis with LMWH significantly lowered a risk of VTE when compared to patients without such prophylaxis. Furthemore, analysis of the subgroup of 102 patients revealed that higher LMWH doses achieved full prophylaxis in 28 patients while lower doses were less effective leading to DVT in 3 out of 39 patients.
In contrast, VTE was diagnosed in 5 out of 35 patients without any LMWH prophylaxis. Conclusions: Prohpylaxis with LMWH leads to a significant of the risk of thromboembolic complications during the induction chemotherapy in patients suffering from MM.
The prophylactic effect of LMWH is dose-dependent.