FACULTY COMMENTS
DR JAKUBOWIAK: This is an important paper based on a good
analysis of the available data. Dr Palumbo and colleagues
concluded that there are two good primary preventive measures
for thrombosis, or VTE. Essentially, they stratified patients based
on a number of risk factors. If there is less than or equal to one
risk factor, they believe aspirin is appropriate. For patients with
more than one risk factor, they recommend low molecular weight
heparin or full-dose anticoagulation with warfarin.
A few years ago we were surprised to learn that lenalidomidebased regimens were associated with an increased risk of clotting. Previously, it was an obvious risk for thalidomide combinations, and it may also be true for some bortezomib-based combinations, so stratification of patients is important. This paper provides some guidelines and will decrease morbidity. I adopted this stratification strategy in my practice, and subsequently I have never had a patient experience a DVT.
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