Deep vein thrombosis (DVT and Pulmonary embolism (PE) are the most common types of thromboembolism or thrombosis (blood clots).The risk of developing a blot clot is increased in any patient with cancer for a number of reasons. Cancer cells, including myeloma cells, release substances that may promote thrombosis. MM patients may be less active, may require hospitalization, often have other chronic illnesses such as diabetes, coronary artery disease or high blood pressure hypertension), and commonly receive medications to treat these chronic diseases which can increase the risk of developing a blood clot. Surgical procedures such as placement of a central venous catheter may also increase the risk. Some patients may have a family history which puts them at increased risk of thromboembolism. Smoking, obesity and a sedentary lifestyle may also increase the risk of a blood clot.
Prevention of thromboembolism
The best strategy to reduce the risk of thromboembolism is to screen each patient carefully for individual and disease related risk factors. Patients with any type of cancer, including MM are considered to have one risk factor as a result of the diagnosis itself. Treatment for MM with certain drugs such as thalidomide, lenalidomide or doxorubicin may increase the risk of thrombosis, particularly when combined with higher doses of dexamethasone (4 days in a row followed by 4 days off). Reducing the dexamethasone dose to once weekly has been shown to decrease the risk of thrombosis while providing effective MM treatment. Effective treatment of the MM may reduce the risk of thrombosis.
The International Myeloma Working Group (IMWG) suggests prevention strategies for patients with increased risk of thromboembolic events. For individuals with only one risk factor a daily dose of aspirin (81 or 325 mg) is recommended. Use of prescribed anticoagulation medications such as low-molecular weight heparin or warfarin (Coumadin) is recommended for patients with more than one risk factor. These treatments do require close monitoring to be sure they are effective and no other side effects such as bleeding occur.
What can you do to reduce your risk?
Notifying your health care provider for any symptoms that may indicate thromboembolism such as painful swelling in an extremity (DVT) or rapid onset of chest pain and shortness of breath (PE) will allow immediate treatment and can reduce the risk of more serious complications. Daily physical activity, avoiding sitting for long-periods of time, regular review of medications, weight loss and smoking cessation can also reduce the risk of thrombosis.
Sandra E. Kurtin, RN, MS, AOCN, ANP-C
Hematology/Oncology Nurse Practitioner
Arizona Cancer Center
Clinical Assistant Professor of Nursing
Clinical Assistant Professor of Medicine University of Arizona Tucson, Arizona
Editor's Note: Use of any medications, even "over the counter" non-prescription medications and/or dietary supplements should always be discussed with your health care professional before taking any action.