A patient with multiple myeloma is at increased risk for multiple myeloma. A number of other factors may raise the risk even higher, making thromboprophylaxis necessary.


Baseline risk for thrombosis associated with multiple myeloma: high


Additional risk factors for thromboembolism:

(1) prolonged immobility

(2) high serum concentrations of monoclonal proteins

(3) therapy with thalidomide

(4) cytotoxic chemotherapy

(5) therapy with dexamethasone

(6) hereditary hypercoagulability

(7) chromosome 13 abnormalities in the myeloma cells

(8) age > 60 years

(9) elevated serum LDH concentration

(10) elevated serum creatinine (>= 2 mg/dL)

(11) disseminated disease

(12) smoking

(13) hypetension

(14) high levels of Factor VIII coagulant activity and/or von Willebrand factor antigen

(15) recent diagnosis of the myeloma


Defibrotide may reduce the risk of thromboembolism, especially in patients being treated with thalidomide.


Thromboprophylaxis may be necessary in a patient with multiple myeloma. Aspirin, low molecular weight heparin (LMWH) and some of the newer antithrombotic agents may be considered for this purpose.


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