Disparity seen between anticoagulation prescription, guidelines
Prescribing of prophylactic anticoagulation appears to be inconsistent with current practice guidelines, suggests a recent study. However, there appears to be lower thromboembolic events than recorded in previously published literature.
Of the 130 patients included in the study, 92 (70.8 percent) were prescribed lenalidomide and 38 (29.2 percent) pomalidomide. Nearly half of the patients (n=54; 41.5 percent) had a total risk score of 2. Aspirin 81 mg oral tablet was the most common prescription (n=53; 40.8 percent), followed by no anticoagulation (n=30; 23.1 percent).
A total of 27 patients (20.8 percent) were prescribed anticoagulation in accordance with National Comprehensive Cancer Network guidelines. The most common adverse event was incidence of deep venous thromboembolism (n=4; 3.1 percent), followed by major bleeding (n=1; 0.8 percent). There were no reported incidence of pulmonary embolism, myocardial infarction or stroke.
This retrospective study at an ambulatory oncology clinic evaluated overall adherence to guideline recommendations for anticoagulation therapy with lenalidomide and pomalidomide in multiple myeloma patients. The authors utilized chart reviews from the calendar years 2013–2016.
Prescription of appropriate anticoagulation upon initiation of therapy based on a list of predetermined risk factors was the primary endpoint, while secondary endpoints included incidence of deep venous thromboembolism, pulmonary embolism, myocardial infarction, stroke and major bleeding; initial anticoagulant prescribed; and whether or not anticoagulation was prescribed for another disease state.
“Lenalidomide and pomalidomide are two immunomodulatory medications with the potential to improve outcomes for patients with multiple myeloma; however, a black box warning for venous thromboembolism exists,” the authors said.