MDCalc

IMPEDE-VTE

Predicts risk of venous thromboembolism (VTE) in multiple myeloma.

This calculator includes inputs based on race, which may or may not provide better estimates, so we have decided to make race optional. Learn more about our approach to addressing race and bias on MDCalc.

Ensure you know your patient’s medication history, VTE history, and fracture history to utilize this score.

Immunomodulatory drug use

BMI ≥25 kg/m2

Pelvic, hip, or femur fracture

Erythropoiesis-stimulating agent

Doxorubicin use

Dexamethasone use

Ethnicity/race is Asian/Pacific Islander

History of VTE before MM

Tunneled line/central venous catheter

Existing thromboprophylaxis: therapeutic or warfarin use

Existing thromboprophylaxis: prophylactic LMWH or aspirin use

Result:

Please fill out required fields.
Advice
  • This tool should not be the sole basis for VTE thromboprophylaxis decisions in patients with multiple myeloma; clinicians should use their judgment and a full clinical evaluation. 
  • Risk stratification can help guide whether patients with multiple myeloma who will receive chemotherapy within 6 months of diagnosis should receive aspirin or anticoagulant thromboprophylaxis.
Management
  • Per 2022 NCCN Guidelines, for patients with a score:
    • ≤3: Consider aspirin 81-325 mg once daily.
    • ≥4: Consider thromboprophylaxis with enoxaparin 40 mg daily, rivaroxaban 10 mg daily, apixaban 2.5 mg twice daily, fondaparinux 2.5 mg daily, or warfarin (target INR 2.0-3.0).
  • Guidelines advise an indefinite duration of VTE prophylaxis while on myeloma therapy. 
  • Clinicians could consider 3-6 months of anticoagulant thromboprophylaxis followed by aspirin, unless additional patient-, treatment-, or transient VTE risk factors suggest a longer duration of anticoagulation.

Critical Actions

Clinicians should consider both the risk of VTE as well as the risk of bleeding when determining whether to prescribe thromboprophylaxis anticoagulation.

Have feedback about this calculator?