@article{3138240,
    title = "Prevention of thalidomide- and lenalidomide-associated thrombosis in
myeloma",
    author = "Palumbo, A. and Rajkumar, S. V. and Dimopoulos, M. A. and Richardson, P. and G. and Miguel, J. San and Barlogie, B. and Harousseau, J. and Zonder, J. and A. and Cavo, M. and Zangari, M. and Attal, M. and Belch, A. and Knop, S. and and Joshua, D. and Sezer, O. and Ludwig, H. and Vesole, D. and Blade, J. and and Kyle, R. and Westin, J. and Weber, D. and Bringhen, S. and and Niesvizky, R. and Waage, A. and von Lilienfeld-Toal, M. and Lonial, S. and and Morgan, G. J. and Orlowski, R. Z. and Shimizu, K. and Anderson, K. and C. and Boccadoro, M. and Durie, B. G. and Sonneveld, P. and Hussein, M. and A. and Int Myeloma Working Grp",
    journal = "Leukemia Research",
    year = "2008",
    volume = "22",
    number = "2",
    pages = "414-423",
    publisher = "Nature Publishing Group",
    issn = "0145-2126",
    doi = "10.1038/sj.leu.2405062",
    keywords = "thrombosis; prophylaxis; risk factors; thalidomide; lenalidomide",
    abstract = "The incidence of venous thromboembolism (VTE) is more than 1%omicron
annually in the general population and increases further in cancer
patients. The risk of VTE is higher in multiple myeloma (MM) patients
who receive thalidomide or lenalidomide, especially in combination with
dexamethasone or chemotherapy. Various VTE prophylaxis strategies, such
as low-molecular-Weight heparin (LMWH), warfarin or aspirin, have been
investigated in small, uncontrolled clinical studies. This manuscript
summarizes the available evidence and recommends a prophylaxis strategy
according to a risk-assessment model. Individual risk factors for
thrombosis associated with thalidomide/lenalidomide-based therapy
include age, history of VTE, central venous catheter, comorbidities
(infections, diabetes, cardiac disease), immobilization, surgery and
inherited thrombophilia. Myeloma-related risk factors include diagnosis
and hyperviscosity. VTE is very high in patients who receive high-dose
dexamethasone, doxorubicin or multiagent chemotherapy in combination
with thalidomide or lenalidomide, but not with bortezomib. The panel
recommends aspirin for patients with <= 1 risk factor for VTE. LMWH
(equivalent to enoxaparin 40 mg per day) is recommended for those with
two or more individual/myeloma-related risk factors. LMWH is also
recommended for all patients receiving concurrent high-dose
dexamethasone or doxorubicin. Full-dose warfarin targeting a therapeutic
INR of 2-3 is an alternative to LMWH, although there are limited data in
the literature with this strategy. In the absence of clear data from
randomized studies as a foundation for recommendations, many of the
following proposed strategies are the results of common sense or derive
from the extrapolation of data from many studies not specifically
designed to answer these questions. Further investigation is needed to
define the best VTE prophylaxis."
}