다발골수종 환자의 정맥혈전색전증 위험 계층화 및 항혈전제 사용 현황
Stratification of Venous Thromboembolism Risk in Multiple Myeloma and Analysis of the Use of Antithrombotic Agents
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Background : The risk of venous thromboembolism (VTE) increases in multiple myeloma (MM), and the National Comprehensive Cancer Network (NCCN) guidelines recommend VTE prevention using the IMPEDE VTE score. Although there have been studies analyzing the correlation between score increase and VTE incidence, there is a lack of validation on Asian ethnicity. This study applies the IMPEDE VTE score to MM patients to stratify the risk of VTE and analyze VTE incidences and the use of antithrombotics. Methods : We conducted a retrospective analysis of electronic medical records of patients newly diagnosed with MM who visited the Hematology Department of a single-center from January 2018 to December 2021. The occurrence of VTE was followed up for 6 months after treatment initiation. The IMPEDE VTE score was calculated at the start of treatment, and the incidence of VTE and the use of anti-thrombotic drugs were analyzed according to risk. Results : Among 239 patients, 139 (58.2%), 98 (41.0%), and 2 (0.8%) were classified in the low-risk (≤3 points), intermediate-risk (4-7 points), and high-risk group (≥8 points) respectively. Age was significantly higher in the low-risk group than intermediate-risk group. Two cases of VTE occurred within 6 months of treatment initiation, both of which were in the low-risk group. Fifty-one patients (21.3%) received antithrombotics that according to the guideline, and all of them were in the low-risk group. There were 14 cases of bleeding associated with the use of antithrombotics. Conclusion : This study highlights the potential association between age and VTE risk in MM patients. While the current guideline does not consider patients’ age as a risk factor, the higher incidence of VTE in the low-risk group of older patients suggests that old age may need to be taken into account when predicting VTE in MM. Further large-cohort studies are needed to investigate this association and to develop guidelines for VTE risk prediction and prevention in MM patients in Korea.
Abstract
Background : The risk of venous thromboembolism (VTE) increases in multiple myeloma (MM), and the National Comprehensive Cancer Network (NCCN) guidelines recommend VTE prevention using the IMPEDE VTE score. Although there have been studies analyzing the correlation between score increase and VTE incidence, there is a lack of validation on Asian ethnicity. This study applies the IMPEDE VTE score to MM patients to stratify the risk of VTE and analyze VTE incidences and the use of antithrombotics. Methods : We conducted a retrospective analysis of electronic medical records of patients newly diagnosed with MM who visited the Hematology Department of a single-center from January 2018 to December 2021. The occurrence of VTE was followed up for 6 months after treatment initiation. The IMPEDE VTE score was calculated at the start of treatment, and the incidence of VTE and the use of anti-thrombotic drugs were analyzed according to risk. Results : Among 239 patients, 139 (58.2%), 98 (41.0%), and 2 (0.8%) were classified in the low-risk (≤3 points), intermediate-risk (4-7 points), and high-risk group (≥8 points) respectively. Age was significantly higher in the low-risk group than intermediate-risk group. Two cases of VTE occurred within 6 months of treatment initiation, both of which were in the low-risk group. Fifty-one patients (21.3%) received antithrombotics that according to the guideline, and all of them were in the low-risk group. There were 14 cases of bleeding associated with the use of antithrombotics. Conclusion : This study highlights the potential association between age and VTE risk in MM patients. While the current guideline does not consider patients’ age as a risk factor, the higher incidence of VTE in the low-risk group of older patients suggests that old age may need to be taken into account when predicting VTE in MM. Further large-cohort studies are needed to investigate this association and to develop guidelines for VTE risk prediction and prevention in MM patients in Korea.
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