Anaissie et al identified risk factors for venous thromboembolism and/or pulmonary embolism in a patient with multiple myeloma. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Arkansas for Medical Sciences and University of Oklahoma Health Sciences Center.


Patient selection: multiple myeloma


Risk factors for venous thromboembolism:

(1) history of venous thromboembolism

(2) thalidomide therapy

(3) prophylactic erythropoietin therapy



• Hypercoagulability is probably a surrogate for history of venous thromboembolism.

• All patients had central venous catheters (CVC). The presence of CVC is associated with increased risk of thrombosis.


Additional factors associated with risk of venous thromboembolisk:

(1) platelet count > 350,000 per µL

(2) elevated C-reactive protein

(3) elevated prothrombin time (which may be the effect of warfarin therapy)


Patient management:

(1) The risk was not reduced by thromboprophylaxis with low molecular heparin (LMWH).

(2) Therapy with thalidomide and/or prophylactic erythropoietin should be done with caution in a patient with a history of venous thromboembolism.

(3) Risk factors for thrombosis should be monitored and either avoided or modified.

(4) Therapy with aspirin may be beneficial if the patient has risk factors for arterial thromboembolism.


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