A review of the venous thrombotic issues associated with multiple myeloma.

INTRODUCTION: Patients with multiple myeloma (MM) have an increased risk of venous thromboembolic (VTE) complications. The first reports of high VTE rates date back to 1999 but became more apparent with the introduction of novel agents in the treatment of MM and mostly with immunomodulatory drugs (IMiDs; thalidomide, lenalidomide and pomalidomide). AREAS COVERED: Currently thromboprophylaxis is recommended for patients who receive IMiDs-based regimens and the type of thrombophrophylaxis is based on patient-, disease- and treatment-related risk factors. Making the distinction between the intrinsic risk of thrombosis in MM and the effect of therapy is crucial. The use of aspirin, low molecular weight heparins and warfarin are the recommended drugs but despite their appropriate use the rates of VTE are not completely eliminated. Expert commentary: Research into biomarkers of increased coagulability and their incorporation in risk assessment models could identify patients most likely to benefit from thromboprophylaxis but such models are not widely used in myeloma.