Thromboprophylaxis prescribing and thrombotic event rates in multiple myeloma patients treated with lenalidomide or thalidomide at a specialist cancer hospital. Issue 2 (24th September 2012)

• Record Type: Journal Article
• Authors: Alexander, Marliese; Teoh, Khai C; Lingaratnam, Senthil; Kirsa, Sue; Mellor, James D
• Is Part Of: Asia-Pacific journal of clinical oncology. Volume 9:Issue 2(2013:Jun.)
• Page Start: 169
• Page End: 175
• Publication Date: 2012-09-24
• Subjects: Oncology -- Pacific Area -- Periodicals; Cancer -- Treatment -- Pacific Area -- Periodicals; Cancer -- Pacific Area -- Periodicals; Cancer -- Treatment -- Periodicals; 616.9940095
• DOI: 10.1111/ajco.12013
• Languages: English
• ISSNs: 1743-7555

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ajco12013-sec-0001" sec-type="section"> <title>Aim</title> <p>To assess thromboprophylaxis prescribing patterns against current guidelines and report thromboembolism (TE) incidence in multiple myeloma (MM) patients treated with thalidomide (thal) or lenalidomide (len) at a specialist cancer hospital over a one‐year period.</p> </sec> <sec id="ajco12013-sec-0002" sec-type="section"> <title>Method</title> <p>Dispensing records of thal and len, diagnosis of MM, patients' characteristics, disease status, co‐prescribed medicines including thromboprophylaxis and incidence of TE were extracted from patients' records and a patient survey conducted to identify patients who sourced thromboprophylactic medicines outside the hospital.</p> </sec> <sec id="ajco12013-sec-0003" sec-type="section"> <title>Results</title> <p>Enoxaparin was most the commonly prescribed thromboprophylactic agent (43%), followed by low‐dose aspirin (26%) and therapeutic warfarin (6%). The thromboprophylactic strategy (including no prophylaxis) could not be determined for 22% of patients. TE incidence (with any thromboprophylaxis) was 9.3 and 9.1% in thal‐based and len‐based regimens, respectively.</p> </sec> <sec id="ajco12013-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Both aspirin and enoxaparin thromboprophylaxis were prescribed for patients on both low‐risk and high‐risk immunomodulatory drug‐based regimens, deviating from current consensus guidelines. Treatment of comorbidities constituted the rationale for maintenance on therapeutic warfarin. Fixed low‐dose warfarin was not prescribed. TE event rates (with any thromboprophylaxis) were consistent with those reported in the literature. Documentation of a chosen strategy was lacking for nearly a quarter of patients, resulting in uncertainty of treatment plan for other members of the multidisciplinary treating team. Centers need to work towards evidence‐based institutional guidelines and improving documentation practices for thromboprophylaxis in their MM patients.</p> </sec> </abstract>