Summary
Usage In patients with multiple myeloma (MM), venous thromboembolism (VTE) is a common cause of morbidity and mortality. The Myeloma Working Group (IMWG) developed and validated a risk prediction score to quantify risk of VTE in patients with MM starting chemotherapy (Sanfilippo et al., 2019). The IMPEDE-VTE score comprises the following nine variables: Immunomodulatory drugs (IMDs); Body Mass Index (BMI); Pelvic, hip or femur fracture; use of Erythropoiesis-stimulating agents (ESAs); use of Dexamethasone/Doxorubicin; Ethnicity/Race; VTE history; Tunneled line/CVC; and Existing thromboprophylaxis. The IMEPDE-VTE score outperformed the risk stratification in the IMWG/NCCN guidelines. Sanfilippo et al. (2019) suggest, "Risk assessment can help clinicians select thromboprophylaxis in high-risk patients, and avoid anticoagulants in those at low VTE risk. These data suggest that the IMPEDE VTE score could replace the risk stratification within the current guidelines for identification of patients with MM at high risk of VTE.". Summary VTE The Myeloma Working Group (IMWG) developed and validated a risk prediction score to quantify risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM) starting chemotherapy (Sanfilippo et al., 2019). The IMPEDE-VTE score comprises the following nine variables: Immunomodulatory drugs (IMDs); Body Mass Index (BMI); Pelvic, hip or femur fracture; use of Erythropoiesis-stimulating agents (ESAs); use of Dexamethasone/Doxorubicin; Ethnicity/Race; VTE history; Tunneled line/CVC; and Existing thromboprophylaxis. Scoring and Recommendations The IMPEDE-VTE Score is calculated by the addition of the selected points. VariablePointsUse of Immunomodulatory drugs (IMDs)No 0Yes 4Body Mass Index (BMI) ≥ 25 kg/m²No 0Yes 4Pelvic, hip or femur fractureNo 0Yes 1Erythropoiesis-stimulating agents (ESAs)No 0Yes 1Dexamethasone useNo 0Low dose 2High dose 4Doxorubicin useNo 0Yes 3Ethnicity/Race is Asian or Pacific IslanderNo -3Yes 0History of VTE before multiple myelomaNo 0Yes 5Tunneled line or central venous catheterNo 0Yes 2Existing thromboprophylaxis: i.e. therapeutic LMWH* or warfarin useNo 0Yes -4Existing thromboprophylaxis: i.e. therapeutic LMWH or aspirin useNo 0Yes -3 *LMWH: Low molecular weight heparin IMPEDE-VTE ScoreResult≤ 3Low Risk of VTE within 6 months of treatment initiation.4-7Intermediate Risk of VTE within 6 months of treatment initiation.≥ 8High Risk of VTE within 6 months of treatment initiation.≥ 4Consider VTE prophylaxis in high risk patientsThe 2022 NCCN Guidelines suggest a cutoff of ≥ 4 as high risk.The primary and validation research of the IMPEDE-VTE score suggest a cutoff of ≥ 8 as high risk.Follow the standard of care for your practice. .