MedWire News: Thromboprophylaxis with either aspirin or low molecular weight heparin (LMWH) is associated with a low incidence of venous thromboembolism (VTE) among patients with newly diagnosed multiple myeloma (MM) receiving lenalidomide-based treatment, Italian researchers report.
Antonio Palumbo (University of Torino) and colleagues explain that prevention of VTE is an important consideration during MM treatment because of the increasing use of immunomodulatory agent-based treatment combinations, which are associated with an 11-15% risk for the development of VTE in the absence of thromboprophylaxis.
Furthermore, "the development of thrombotic events is a potentially life-threatening complication that may lead to treatment discontinuations, increases in patient morbidity, and increased healthcare costs," they write in Blood.
In the present study, Palumbo and team compared the efficacy and safety of thromboprophylaxis with low-dose aspirin or the LMWH enoxaparin in patients with newly diagnosed MM, receiving treatment with lenalidomide and low-dose dexamethasone induction and melphalan-prednisone-lenalidomide consolidation.
Overall, 342 patients, aged 18-65 years, who did not have clinical indications or contraindications to antiplatelet or anticoagulant therapy were randomly assigned to receive aspirin 100 mg/day (n=176) or enoxaparin 40 mg/day (n=166).
The median age of patients at diagnosis was 57 years in the aspirin group and 58 years in the enoxaparin group, and the two groups were well balanced in terms of patient characteristics and the number of comorbid conditions.
The researchers report that, during the first 6 months from randomization, the incidence of VTE was marginally higher among patients in the aspirin group, compared with those in the enoxaparin group, at 2.3% versus 1.2%, but the difference was not statistically significant.
Pulmonary embolism was observed in 1.7% of patients in the aspirin group and none in the LMWH group.
No arterial thrombosis, acute cardiovascular events, or sudden deaths were reported in either group. Nor were any major hemorrhagic complications observed.
The researchers note that the small number of VTE events meant they were unable to analyze the association between patient risk factors and the development of VTE.
A further limitation of the study was the exclusion of patients at high risk for VTE, such as those with a history of thromboembolism, severe cardiovascular disease, uncontrolled diabetes, infections, immobilization, or surgery, because of their indication or contraindication to a specific anticoagulant or antiplatelet therapy.
Nevertheless, Palumbo and team conclude: "Aspirin could be considered an alternative option to LMWH for prophylaxis in untreated patients with newly diagnosed MM, with low individual risk of thrombosis."
"The advantages of aspirin include oral administration, safe use in comorbid conditions (eg, renal insufficiency), no need for regular coagulation monitoring, low cost, and the possibility of long-term administration," they add.
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