Safety and efficacy of apixaban as thromboprophylaxis in myeloma patients receiving chemotherapy: A prospective cohort study

Sayar, Zara; Gates, Carolyn; Bristogiannis, Sotirios; Patel, Aisha; Ogunbiyi, M Olabisi; Tailor, Anish; Yong, Kwee; Thomas, Mari

doi:10.1016/j.thromres.2022.03.001

Cited by 9 publications

(15 citation statements)

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“…53 The Data are accumulating regarding the use of apixaban in primary VTE prevention in MM patients treated with IMiDs (Table 4). [54][55][56][57] Four recent studies comprising 306 patients in total have evaluated VTE and bleeding rates with the use of apixaban at 2.5 mg twice daily for at least 6 months, with only two recorded VTE events (0.6%): an asymptomatic proximal deep vein thrombosis and a symptomatic distal DVT; in the latter case, apixaban was stopped 14 days before). The pooled data revealed three episodes of major haemorrhage (1%).…”

Section: Primary Antithrombotic Prophylaxismentioning

confidence: 99%

“…The pooled data revealed three episodes of major haemorrhage (1%). [54][55][56][57] Preliminary data on the efficacy and safety of apixaban and rivaroxaban as primary thromboprophylaxis in patients receiving IMiDs are promising. However, there is no strong evidence in favor of DOACs instead of LMWH.…”

Section: Primary Antithrombotic Prophylaxismentioning

confidence: 99%

“…Primary antithrombotic prophylaxis in multiple myeloma: results of two randomized clinical trials [50,51] and of studies addressing the use of apixaban or rivaroxaban [35,[55][56][57][58] ATE: arterial thrombotic event; DVT: deep vein thrombosis; MB: major bleeding; PE: pulmonary embolism; SVT: superficial vein thrombosis; IMIDs: immunomodulatory drugs (Thal or Lena or Poma); Thal: thalidomide; Lena: lenalidomide; Poma: pomalidomide; RVD: Lenalidomide, Bortezomib, Dexamethasone; KRD: Lenalidomide, Carfilzomib, Dexamethasone; n.r. : not reported…”

Section: Tablementioning

confidence: 99%

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Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an <i>ad hoc</i> expert panel

et al. 2022

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The introduction of new therapeutic agents in multiple myeloma (MM), including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, has improved the outcomes of patients but, in parallel, has changed the frequency and epidemiology of thrombotic events. Now, thrombosis is a significant cause of morbidity and mortality in MM patients, and optimal thromboprophylaxis is far from being reached. Moving from the recognition that the above issue represents an unmet clinical need, an Expert Panel assessed the scientific literature and composed a framework of recommendations for improving thrombosis control in patients candidates for active treatment for MM. The Panel generated clinical key questions using the criterion of clinical relevance through a Delphi process. It explored four domains, i.e., thrombotic risk factors and risk stratification, primary thromboprophylaxis, management of acute thrombotic events, and secondary thromboprophylaxis. The issued recommendations may assist hematologists in minimizing the risk of thrombosis and guarantee adherence to treatment in patients with MM candidates to active treatment.

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Section: Primary Antithrombotic Prophylaxismentioning

confidence: 99%

Section: Primary Antithrombotic Prophylaxismentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

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Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an <i>ad hoc</i> expert panel

et al. 2022

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“…Other agents with anti-myeloma activity, such as the monoclonal antibodies, daratumumab, belantamab and elotuzumab, and the oral proteasome inhibitor ixazomib, have not been associated with an increased risk of thrombotic complications [ 67 , 68 , 69 , 70 ], at least in the clinical trial setting. In the GRIFFIN study, daratumumab with VRD (DVRd) was compared to VRd, and the all-grade cumulative rates of VTE were 10% and 15%, respectively [ 73 ].…”

Section: Literature Reviewmentioning

confidence: 99%

“…In addition, no increase in bleeding risk was reported [ 68 ]. The safety and efficacy of apixaban thromboprophylaxis at 2.5 mg twice daily for at least six months in patients with NDMM who receive IMiDs have been evaluated in four recent trials in a total of 306 patients [ 54 , 56 , 57 , 69 ]. In the pooled data, two VTE events (0.6%) were reported, along with three episodes of major hemorrhage (1%).…”

Section: Literature Reviewmentioning

confidence: 99%

Approach to Contemporary Risk Assessment, Prevention and Management of Thrombotic Complications in Multiple Myeloma

Fotiou

Dimopoulos

2022

Cancers

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Multiple myeloma (MM) is associated with an increased risk of thrombotic complications, which remains substantial despite the implementation of thromboprophylaxis. The procoagulant state that characterizes the disease is multifactorial, and a greater understanding of the underlying pathophysiology is required to inform appropriate thrombosis prevention. Currently, there is a shift towards using direct oral anticoagulants (DOACs) in this setting; head-to-head comparisons in the context of controlled clinical trials between class agents are still missing. MM-specific VTE risk assessment scores have been developed to optimize management and minimize the associated mortality/morbidity. Their clinical utility remains to be evaluated. The value of adding biomarkers to clinical scores to optimize their performance and increase their discriminatory power is also under assessment.

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Thrombosis in multiple myeloma: Risk estimation by induction regimen and association with overall survival

et al. 2023

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Lenalidomide‐containing (R) triplet and quadruplet regimens are the standard of care for multiple myeloma (MM) and have been shown to increase the risk of thrombosis. The association between thromboembolism (TE) and survival in the novel multidrug era is not yet delineated. In this study, we evaluated the incidence of TE during the first year of MM diagnosis, its association with the type of induction regimen, and its impact on overall survival. We studied 672 newly diagnosed MM (NDMM) patients who received a triplet or quadruplet lenalidomide‐based induction at the Mayo Clinic, Rochester. TE was diagnosed in 83 patients (12.4%). Of these, 56 (8.3%) had a deep venous thrombosis (DVT), 23 (3.4%) had a pulmonary embolism (PE) with or without the DVT, and 4 (0.6%) patients had a stroke. Carfilzomib‐Rd (KRd) had the highest risk of TE (21.1%, 18/85), followed by quadruplets (11.1%, 5/45), bortezomib‐Rd (9.6%, 51/531), and 0/11 (0%), treated with other lenalidomide‐containing regimens. The difference in TE risk between KRd and the other regimens was statistically significant (OR = 2.6, p < .01). Nine patients developed a TE before being exposed to any treatment. Survival was significantly lower among patients that developed a TE (66 vs. 133 months, p < .01). The association of TE with reduced survival demonstrated in univariate analysis (HR = 2.2, 95% CI = 1.6–3.3) was maintained in the multivariable analysis adjusted for high‐risk interphase fluorescence in situ hybridization (FISH), sex, age, receipt of an upfront transplant, the response at induction, and the International Staging System (ISS) (HR = 2.61, CI = 1.74–3.9). We conclude that TE is an important aspect of MM management, and effective management is especially relevant in the novel treatment era.

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Safety and efficacy of apixaban as thromboprophylaxis in myeloma patients receiving chemotherapy: A prospective cohort study

Cited by 9 publications

References 10 publications

Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an <i>ad hoc</i> expert panel

Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an <i>ad hoc</i> expert panel

Approach to Contemporary Risk Assessment, Prevention and Management of Thrombotic Complications in Multiple Myeloma

Thrombosis in multiple myeloma: Risk estimation by induction regimen and association with overall survival

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