Let’s start with a quick wake-up call : multiple myeloma is associated with a 9-fold increase in the risk of having a venous thromboembolism (VTE) or in layman’s terms a blood-clot that forms in a vein and that migrates to another location. Blood-clots cause all sorts of problems with the best known probably being stroke. Both the Association of Clinical Oncologists (ASCO) and the International Myeloma Working Group (IMWG) have recommended in the past that select MM patients be given ‘thromboprophylaxis’. This dynamite Scrabble word means therapy to prevent blood-clots from forming. ASCO recommends low-molecular-weight heparin injections (brand name Lovenox or generic name enoxaparin) or low-dose aspirin in patients receiving immunomodulatory drugs (IMIDs) in combination with chemotherapy and/or dexamethasone. The IMWG has recommended low-dose aspirin for MM patients with one or no VTE risk factors including those on lenalidomide in combination with low-dose dexamethasone, melphalan or doxorubicin. A paper presented at ASH 2017 has now raised some questions about the adequacy of aspirin. The authors reviewed records of nearly 5,000 MM patients that had been treated for myeloma within the US Veterans Health Administration System of whom 582 developed VTE. Risk factors for VTE after a myeloma diagnosis included : history of prior VTE, lenalidomide and thalidomide. Some patients were treated with warfarin to prevent blood-clots, others had been given low dose aspirin. Key results are :
offers an additional perspective about the potential use of rivaroxaban (brand name Xarelto) as an alternative. There are some interesting comments made in this paper :
In a nutshell: injections of enoxaparin (low molecular heparin) is considered the current standard of care for cancer associated blood-clots, low dose aspirin may not do the trick but Xarelto may be an option. So, the question for the patient is: do you want to mess with a proven standard-of-care and its daily bee-sting or migrate to something else that you can pop with all the other oral drugs you already take, just for the sake of convenience? Something to discuss with your physician.
about the author
Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can help accelerate a cure by weighing in and participating in clinical research. Founder of Myeloma Crowd by HealthTree and the HealthTree Foundation.