title: Thromboprophylaxis prescribing and thrombotic event rates in multiple myeloma patients treated with lenalidomide or thalidomide at a specialist cancer hospital.
abstract: OBJECTIVE
  To assess thromboprophylaxis prescribing patterns against current guidelines and report thromboembolism (TE) incidence in multiple myeloma (MM) patients treated with thalidomide (thal) or lenalidomide (len) at a specialist cancer hospital over a one-year period.
  
  
  METHODS
  Dispensing records of thal and len, diagnosis of MM, patients' characteristics, disease status, co-prescribed medicines including thromboprophylaxis and incidence of TE were extracted from patients' records and a patient survey conducted to identify patients who sourced thromboprophylactic medicines outside the hospital.
  
  
  RESULTS
  Enoxaparin was most the commonly prescribed thromboprophylactic agent (43%), followed by low-dose aspirin (26%) and therapeutic warfarin (6%). The thromboprophylactic strategy (including no prophylaxis) could not be determined for 22% of patients. TE incidence (with any thromboprophylaxis) was 9.3 and 9.1% in thal-based and len-based regimens, respectively.
  
  
  CONCLUSIONS
  Both aspirin and enoxaparin thromboprophylaxis were prescribed for patients on both low-risk and high-risk immunomodulatory drug-based regimens, deviating from current consensus guidelines. Treatment of comorbidities constituted the rationale for maintenance on therapeutic warfarin. Fixed low-dose warfarin was not prescribed. TE event rates (with any thromboprophylaxis) were consistent with those reported in the literature. Documentation of a chosen strategy was lacking for nearly a quarter of patients, resulting in uncertainty of treatment plan for other members of the multidisciplinary treating team. Centers need to work towards evidence-based institutional guidelines and improving documentation practices for thromboprophylaxis in their MM patients.
authors.affiliation: Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. marliese.alexander@petermac.org
authors.forename: Marliese
authors.initials: M
authors.lastname: Alexander
authors.forename: Khai C
authors.initials: KC
authors.lastname: Teoh
authors.forename: Senthil
authors.initials: S
authors.lastname: Lingaratnam
authors.forename: Sue
authors.initials: S
authors.lastname: Kirsa
authors.forename: James D
authors.initials: JD
authors.lastname: Mellor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D002173:Cancer Care Facilities; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012189:Retrospective Studies; D013038:Specialization; D013792:Thalidomide / Q000009:adverse effects* / Q000031:analogs & derivatives*; D013927:Thrombosis / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D013792:Thalidomide; D014859:Warfarin; D000077269:Lenalidomide; D001241:Aspirin