MDCalc

IMPEDE-VTE

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

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 LMWH or warfarin use

Existing thromboprophylaxis: prophylactic LMWH or aspirin use

Result:

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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.

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