title: Real-life practices for preventing venous thromboembolism in multiple myeloma patients: a cohort study from the French health insurance database.
abstract: OBJECTIVE
  The risk of venous thromboembolic event (VTE) in multiple myeloma is particularly increased. Current guidelines recommend systematic VTE prophylaxis with vitamin K antagonists (VKA) or low weight molecular heparin (LWMH) or unfractionated heparin (UFH) in high-risk patients, based on treatment received [e.g. use of IMiDs (thalidomide, lenalidomide and pomalidomide), alkylating agents or erythropoietin] and individual risk factors (e.g. history of VTE). The aim of this study was to describe strategy of VTE prophylaxis and prescribing of other antithrombotic agents during the first 6 months of multiple myeloma therapy, with stratification on IMiD-based regimens and drug and disease-related risk factors.
  
  
  METHODS
  A retrospective cohort study of French beneficiaries from the health insurance database (SNIIRAM, Système National d'Information Inter-Régime de l'Assurance Maladie) was designed in the Midi-Pyrénées area (South West France). Patients starting a treatment for multiple myeloma in the period 2011-2014 were identified through hospital and chronic disease diagnoses.
  
  
  RESULTS
  Among the 236 incident multiple myeloma patients, 56% male (n = 133), 67% >65 years (n = 159) and 47% (n = 110) patients received an IMiD-based regimen. In these patients, 63% (n = 69) were identified as high-risk patients with indication for low molecular weight heparin or equivalent, and 37% (n = 41) were identified as low-risk with aspirin recommended. Among the high-risk IMiDs patients, 43% (30/69) currently received a VTE prophylaxis after starting their first regimen: 70% LWMH (21/30), 40% VKA (12/30), 10% UFH (3/30) and 13% (4/30) other drugs (rivaroxaban and fondaparinux); 33% of the patients (23/69) received an antiplatelet drug only, and 23% (16/69) did not receive any antithrombotic drug.
  
  
  CONCLUSIONS
  These results revealed lack of implementation of VTE prophylaxis in one out of high-risk multiple myeloma patients with IMiD. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Medical and Clinical Pharmacology department, Toulouse University Hospital, Toulouse, France.|UMR INSERM 1027, University of Toulouse, Toulouse, France.|CIC 1436, Toulouse University Hospital, Toulouse, France.
authors.forename: Aurore
authors.identifier: http://orcid.org/0000-0002-5660-9224
authors.initials: A
authors.lastname: Palmaro
authors.affiliation: UMR INSERM 1027, University of Toulouse, Toulouse, France.|Academic Department of Family Medicine, Faculty of Medicine Toulouse, University of Toulouse, Toulouse, France.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Rougé-Bugat
authors.affiliation: Department of Haematology, Toulouse University Hospital, Toulouse, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Gauthier
authors.affiliation: Medical and Clinical Pharmacology department, Toulouse University Hospital, Toulouse, France.|UMR INSERM 1027, University of Toulouse, Toulouse, France.|CIC 1436, Toulouse University Hospital, Toulouse, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Despas
authors.affiliation: Medical and Clinical Pharmacology department, Toulouse University Hospital, Toulouse, France.|UMR INSERM 1027, University of Toulouse, Toulouse, France.|CIC 1436, Toulouse University Hospital, Toulouse, France.|Department of Internal Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Moulis
authors.affiliation: Medical and Clinical Pharmacology department, Toulouse University Hospital, Toulouse, France.|UMR INSERM 1027, University of Toulouse, Toulouse, France.|CIC 1436, Toulouse University Hospital, Toulouse, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005602:France / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D006493:Heparin
keywords: France; SNIIRAM; electronic healthcare records; lenalidomide; multiple myeloma; pharmacoepidemiology; thalidomide; venous thromboembolism