Update of thrombosis in multiple myeloma

• Newly diagnosed multiple myeloma is associated with an increased risk of venous and arterial thrombosis
• New anti-myeloma agents seem to have a lower thrombosis risk than conventional chemotherapy in combination with IMIDs
• Venous thrombosis in multiple myeloma patients should be treated with at least 6 months of low molecular weight heparin. Direct acting oral anticoagulant drugs are not yet recommended

ABSTRACTWith the introduction of thalidomide and multi-agent chemotherapy in the treatment of multiple myeloma around 15 years ago a strongly increased risk of venous thrombosis was observed. The occurrence of venous thrombosis in multiple myeloma is not only determined by the kind of treatment, but also by several other factors, including disease specific factors, patient-specific factors, changes in pro-and anticoagulant factors and fibrinolysis. Studies showed a prevalence of up to 25% in patients with newly diagnosed multiple myeloma. Therefore these patients nowadays receive prophylaxis with aspirin, low molecular weight heparin or warfarin in order to reduce the risk of venous thrombosis. It is however still debatable which patients should receive prophylaxis and what the best kind of prophylaxis is, considering both the risk of thrombosis and the risk of bleeding. In recent years several new anti-myeloma agents have been developed and investigated in large clinical studies. The risk of thrombosis using these new drugs seems less than with thalidomide and lenalidomide-based regimens. In this article an update on prevention and management of thrombotic events in patients with multiple myeloma is given.