title: Low molecular weight heparins for thromboprophylaxis during induction chemotherapy in patients with multiple myeloma.
abstract: BACKGROUND
  Patients with multiple myeloma have a high risk of venous thromboembolism (VTE), especially during the induction chemotherapy. The aim of our observational study was to determine the impact of prophylaxis with low molecular weight heparin (LMWH) on the incidence of thromboembolic complications.
  
  
  METHODS
  We analyzed the incidence of thromboembolic events in 258 patients treated with induction chemotherapy containing vincristin, doxorubicin or idarubicin, and dexamethasone, followed by stimulation chemotherapy with cyclophosphamide and G-CSF, and high-dose chemotherapy with melphalan. Two groups of these patients were compared based on the practice of thromboprophylaxis. Patients in the first group (Control, n = 140) were either not treated or treated with a short duration of anticoagulation therapy while the patients in the second group (Prophylactic, n = 118) underwent standard prophylaxis with LMWH throughout the entire period of induction chemotherapy. A total of 102 patients were selected for a close monitoring of the prophylactic effect of different LMWH doses and to be compared to patients without treatment.
  
  
  RESULTS
  Standard prophylaxis with LMWH significantly (p < 0.007) lowered a risk of VTE when compared to patients without such prophylaxis (3.4% versus 12.9%, respectively). Furthermore, analysis of the subgroup of 102 patients revealed that higher LMWH doses (> 70 IU/kg per day) achieved full prophylaxis in 28 patients while lower doses were less effective leading to DVT in 3 (7.7%) out of 39 patients. In contrast, VTE was diagnosed in 5 (14.3%) out of 35 patients without any LMWH prophylaxis.
  
  
  CONCLUSIONS
  Prophylaxis with LMWH leads to a significant reduction of the risk of thromboembolic complications during the induction chemotherapy in patients suffering from MM. The prophylactic effect of LMWH is dose-dependent.
authors: Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic pkessler@hospital-pe.cz
authors: P
authors: P
authors: Kessler
authors: L
authors: L
authors: Pour
authors: E
authors: E
authors: Gregora
authors: M
authors: M
authors: Zemanova
authors: M
authors: M
authors: Penka
authors: M
authors: M
authors: Brejcha
authors: Z
authors: Z
authors: Adam
authors: J
authors: J
authors: Bacovsky
authors: M
authors: M
authors: Fenclova
authors: H
authors: H
authors: Frankova
authors: P
authors: P
authors: Hausdorf
authors: L
authors: L
authors: Walterova
authors: V
authors: V
authors: Heinzova
authors: M
authors: M
authors: Holikova
authors: M
authors: M
authors: Krejci
authors: K
authors: K
authors: Kubackova
authors: E
authors: E
authors: Langrova
authors: V
authors: V
authors: Maisnar
authors: I
authors: I
authors: Meluzinova
authors: Y
authors: Y
authors: Stavarova
authors: J
authors: J
authors: Straub
authors: V
authors: V
authors: Scudla
authors: J
authors: J
authors: Gumulec
authors: J
authors: J
authors: Ullrychova
authors: R
authors: R
authors: Hajek
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight