title: Evidence-based case report: multiple thrombotic episodes associated with lenalidomide and dexamethasone therapy for multiple myeloma.
abstract: Lenalidomide in combination with dexamethasone is a treatment for patients with relapsed or refractory myeloma. Although this combination demonstrates a high level of efficacy, it further exacerbates the hypercoaguable state that exists within myeloma. Thromboprophylactic regimen require careful selection and if warfarin is chosen, assiduous monitoring is required to ensure it will be clinically effective. We report the case of one patient who experienced multiple thrombotic events despite anticoagulant or antiplatelet thromboprophylaxis and review the contributing factors.
authors.affiliation: Advanced Pharmacist Clinical Research, Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK.
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Rushworth
authors.affiliation: NHS Highland, Raigmore Hospital, and University of Stirling, Inverness, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
authors.affiliation: NHS Highland, Raigmore Hospital, Inverness, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Forsyth
authors.affiliation: NHS Highland, Raigmore Hospital, Inverness, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Vincent
keywords: dexamethasone; drug safety; lenalidomide; multiple myeloma; myocardial infarction; pulmonary embolus; thrombosis
references.citation: Ther Clin Risk Manag. 2008 Feb;4(1):129-36
references.pmid: 18728702
references.citation: Mayo Clin Proc. 2003 Jan;78(1):21-33
references.pmid: 12528874
references.citation: Leuk Lymphoma. 2007 Dec;48(12):2295-7
references.pmid: 18066998
references.citation: Blood. 2005 Dec 15;106(13):4050-3
references.pmid: 16118317
references.citation: Blood. 2006 Nov 15;108(10):3458-64
references.pmid: 16840727
references.citation: Thromb Res. 2009 Mar;123(5):679-86
references.pmid: 18992924
references.citation: J Hematol Oncol. 2009 Aug 12;2:36
references.pmid: 19674465
references.citation: Blood. 2000 Nov 1;96(9):2943-50
references.pmid: 11049970
references.citation: J Clin Oncol. 2009 Oct 10;27(29):4848-57
references.pmid: 19752334
references.citation: Semin Hematol. 2009 Apr;46(2):143-57
references.pmid: 19389498
references.citation: N Engl J Med. 2007 Nov 22;357(21):2133-42
references.pmid: 18032763
references.citation: Med Oncol. 2010 Sep;27(3):646-53
references.pmid: 19582597
references.citation: N Engl J Med. 2007 Nov 22;357(21):2123-32
references.pmid: 18032762
references.citation: Br J Haematol. 2009 Jul;146(2):164-70
references.pmid: 19545290
references.citation: Eur J Cancer. 2010 Jul;46(10):1790-9
references.pmid: 20385482
references.citation: Ann Hematol. 2009 Jan;88(1):67-71
references.pmid: 18668241
references.citation: Br J Haematol. 2011 Jul;154(1):32-75
references.pmid: 21569004
references.citation: J Clin Oncol. 2009 Oct 10;27(29):4865-73
references.pmid: 19704059
references.citation: Blood. 2006 Jul 1;108(1):403; author reply 404
references.pmid: 16790586
references.citation: Lancet. 2009 Jul 25;374(9686):324-39
references.pmid: 19541364
references.citation: J Clin Pharm Ther. 2008 Jun;33(3):219-26
references.pmid: 18452408
references.citation: Leukemia. 2008 Feb;22(2):414-23
references.pmid: 18094721
references.citation: Mayo Clin Proc. 2005 Dec;80(12):1568-74
references.pmid: 16342649
references.citation: Leuk Lymphoma. 2007 Dec;48(12):2330-7
references.pmid: 18067007
references.citation: Int J Lab Hematol. 2009 Apr;31(2):119-31
references.pmid: 19016917
references.citation: N Engl J Med. 2011 Mar 17;364(11):1046-60
references.pmid: 21410373
references.citation: N Engl J Med. 2006 May 11;354(19):2079-80
references.pmid: 16687729
references.citation: Hematology Am Soc Hematol Educ Program. 2010;2010:437-44
references.pmid: 21239832
references.citation: Blood Rev. 2009 Mar;23(2):87-93
references.pmid: 18774632
references.citation: Cancer. 2011 Apr 1;117(7):1334-49
references.pmid: 21425133