Thromboembolic Events - Multiple Myeloma Center for Nurses

Thromboembolic Events

Thromboembolic Events

The potential for venous thromboembolism (VTE) is a concern in patients with multiple myeloma, in whom the incidence is higher compared with the general population.

Causes are multifactorial, and can include clinical risk factors such as immobility, immunosuppression, and blood hypercoagulability due to treatment; and inherent thrombosis risk factors such as inflammation and activation of procoagulant factors due to disease. VTE is usually recurrent and can lead to long-term complications.1,2

VTE comprises 2 related conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE).2

Signs and Symptoms3

DVT

  • Unilateral swollen, erythematous, and warm extremity
  • Dull ache, pain, or tight feeling over affected area
  • Low-grade fever
  • Distension of superficial venous collateral vessels
  • Positive Homan’s sign

PE

  • Dyspnea or tachypnea
  • Chest discomfort
  • Tachycardia
  • Low-grade fever
  • Pleural rub

Assessment2,3

Complete patient history

 Lab work

  • Electrolytes
  • Serum D-dimer
  • Antithrombin level
  • Prothrombin time, partial thromboplastin time, baseline international normalized ratio (INR)

Imaging may be needed for definitive diagnosis.

Management3

  • Anticoagulation medicines (eg, low-molecular-weight heparin, warfarin, fondaparinux) can be used to help prevent VTE
  • Preventative medications should be used only after assessing each patient’s risk of bleeding versus thrombosis
  • Unfractionated heparin and some oral anticoagulants can be used to manage acute VTE  in patients with multiple myeloma. Patients should be monitored and re-evaluated for risk of VTE at 6 months

For Your Patients3

Make sure patients are familiar with the signs and symptoms of DVT and PE.

Encourage them to address modifiable risk factors, such as

  • Obesity
  • Sedentary lifestyle
  • Smoking

Discuss the use of aspirin/anticoagulants during pregnancy, surgery, long flights or car rides, and treatment with immunomodulatory drugs.

Suggest use of compression socks and devices.

For patients taking an anticoagulant, stress the importance of following healthcare provider instructions and precautions.

References:

  1. Fotiou D, Gavriatopoulou M, Terpos E. Multiple myeloma and thrombosis: prophylaxis and risk prediction tools. Cancers. 2020;12(1):191. doi:10.3390/cancers12010191
  2. Reyes NL, Beckman MG, Abe K. Deep vein thrombosis & pulmonary embolism. Centers for Disease Control and Prevention. Accessed March 15, 2021. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-by-air-land-sea/deep-vein-thrombosis-and-pulmonary-embolism
  3. Noonan K, Rome S, Faiman B, et al. Heart and lung complications: assessment and prevention of venous thromboembolism and cardiovascular disease in patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5):37-46.
Top