HealthTree survey as an identifier of venous thromboembolism risk mitigation targets in newly diagnosed multiple myeloma.

Abstract

e19580 Background: Patients (pts) with newly diagnosed multiple myeloma (NDMM) are at significantly increased risk of venous thromboembolism (VTE). Lack of awareness, appropriate pt counseling and inconsistent performance of risk stratification tools are barriers to effective risk mitigation. Methods: A cross-sectional survey of 579 NDMM pts was conducted via HealthTree. Overall incidence of VTE and SAVED / IMPEDE risk scores were retrospectively calculated using participant electronic health records. Associations between risk mitigation strategies, thrombotic events, types of prophylaxis (ppx) and bleeding rates were evaluated using chi-squared and ANOVA tests with Benjamini-Hochberg adjustments. Results: Median (Q1,Q3) age was 69 (63,73), 88% White, 7% African-American, and 89% received an IMiD-based induction. Incidence of new VTE at any time was 35%, of which 22% occurred in the first year since diagnosis, and additional 13% after year 1. Rate of new/recurrent VTE after year 1 was 20%. Having an academic/myeloma specialist for a provider vs not, pts were less likely to develop a VTE (31% vs 39%). Pt history of prior DVT or PE was a highly significant predictor of VTE vs not (relative risk 2.61, 39% vs 9%). Pts who had a discussion on the risk of VTE (58%) vs not or who did not remember (42%) had a 23.6% lower relative risk of developing a VTE. Similarly, discussing the risk of VTE plus using VTE ppx within the year 1 of diagnosis vs missing either or both had the greatest reduction in the risk of VTE (12-22%, p = 0.001, Table 1). Median (Q1,Q3) SAVED score was 4 (4,5) for both pts who experienced vs not VTE at any time. Median (Q1,Q3) IMPEDE score was 8 (7,10) for pts who experienced VTE at any time, vs 9 (8,10) for those who never had VTE. Overall, 34% of pts were on no VTE ppx of any kind at any point. Among those who suffered VTE at any point, 42% were not on any VTE ppx, 35% were on aspirin (ASA), and 20% were on apixaban or rivaroxaban (api/riva). Of those who were on VTE ppx and suffered VTE vs not, 19% vs 11% had a bleeding event (p = 0.024), with major bleeding rates of 16% vs 9%, respectively (p = 0.021). Overall, 35% of pts with bleeding events were on ASA, and 54% were on api/riva. In all pts with VTE, only 36% received full care as outpatient; 58% had to preset to the emergency room (ER), of which 23% did not need hospital admission, 20% needed one without an intensive care unit (ICU), and 15% needed ICU care. Conclusions: We present the highest VTE incidence rate in NDMM reported in the literature. VTE risk remains present within the first year of diagnosis and beyond. Receiving care by an academic or myeloma specialist, having a discussion on VTE risk and utilising VTE ppx were all factors which mitigated VTE risk. SAVED and IMPEDE scores were not reliably discriminating for the VTE risk, and 77% of pts who had VTE were on no VTE ppx or ASA. Healthcare utilisation rate for VTE management is significant, with over half pts needing ER care.