The use of pharmacy-based monitoring of risk for venous thromboembolism (VTE) among patients with multiple myeloma treated with immunomodulatory drugs effectively decreased risk for VTE events in a population of high-risk patients, according to the results of a single-center study published in the Journal of Oncology Pharmacy Practice.

According to the study, immunomodulatory drugs often used to treat myeloma confer increased risk for VTE. Therefore, consensus opinion guidelines recommend anticoagulant thromboprophylaxis in this population.

A single-center study conducted at Dana-Farber Cancer Institute looked at baseline data to see how thromboprophylaxis strategies are used and sought to improve the rates of anticoagulation for high-risk patients after a quality improvement project that added pharmacy/hematology oversight to VTE risk assessment.

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Every patient starting immunomodulatory drugs during the study period (39 patients) underwent VTE risk assessment by a pharmacist or hematologist, and results and recommendations for prophylaxis were provided to the clinicians managing the patients’ myeloma. Of the patients assessed, 64% were placed on an anticoagulant for thromboprophylaxis. Direct oral anticoagulants were selected as the method of thromboprophylaxis in 79% of these patients.

Eight high-risk patients did not receive anticoagulant thromboprophylaxis and 4 of these patients developed VTE. None of the patients given anticoagulant thromboprophylaxis developed VTE.

Only 5% of complications were attributed to thromboprophylaxis, including 2 minor bleeding events in patients given direct oral anticoagulants.

“Multiple myeloma patients at high risk for VTE benefit from guideline-based thromboprophylaxis facilitated through a pharmacy-based system that offers recommendations to the myeloma provider,” the researchers concluded.


Parnes A, Leblebjian H, Hamilton J, Smith S, Laubach J, Berliner N. Improving rates of venous thromboembolism prophylaxis in multiple myeloma patients on immunomodulatory drugs through a pharmacy-based system. J Oncol Pharm Practice. Published online February 20, 2021. doi:10.1177/1078155221995885