IMPEDE-VTE

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.

 

 

Variable	Points
Use of Immunomodulatory drugs (IMDs)	No               0 Yes              4
Body Mass Index (BMI) ≥ 25 kg/m²	No               0 Yes              4
Pelvic, hip or femur fracture	No               0 Yes              1
Erythropoiesis-stimulating agents (ESAs)	No               0 Yes              1
Dexamethasone use	No               0 Low dose    2 High dose   4
Doxorubicin use	No               0 Yes              3
Ethnicity/Race is Asian or Pacific Islander	No              -3 Yes              0
History of VTE before multiple myeloma	No               0 Yes              5
Tunneled line or central venous catheter	No               0 Yes              2
Existing thromboprophylaxis: i.e. therapeutic LMWH* or warfarin use	No               0 Yes             -4
Existing thromboprophylaxis: i.e. therapeutic LMWH or aspirin use	No               0 Yes             -3

 

*LMWH: Low molecular weight heparin

 

 

IMPEDE-VTE Score	Result
≤ 3	Low Risk of VTE within 6 months of treatment initiation.
4-7	Intermediate Risk of VTE within 6 months of treatment initiation.
≥ 8	High Risk of VTE within 6 months of treatment initiation.
≥ 4	Consider VTE prophylaxis in high risk patients The 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.

 

 

.