Estratificação de Risco e Profilaxia do Tromboembolismo Venoso no Mieloma Múltiplo / Venous Thromboembolism Risk Stratification and Prophylaxis in Multiple Myeloma / Estratificación del Riesgo y Profilaxis del Tromboembolismo Venoso en el Mieloma Múltiple

RESUMO

A trombose representa um desafio no cenário do mieloma múltiplo. O avanço no arsenal terapêutico para o tratamento desse câncer trouxe aumento de sobrevida, mas paralelamente acarretou aumento na incidência dos eventos trombóticos, com impacto na morbidade e na mortalidade. Além disso, o perfil epidemiológico dessa população favorece a coexistência de doença cardiovascular, que compartilha com o câncer mecanismos fisiopatológicos trombogênicos. Assim, apesar do uso de anticoagulantes e antiagregantes plaquetários, a estratégia ideal para profilaxia permanece obscura e o desafio vai além da padronização do modelo de avaliação de risco e da terapia anticoagulante. Este trabalho buscou apresentar o estado da arte sobre o tema com o objetivo de discutir a tromboprofilaxia no mieloma múltiplo, enfatizando a abordagem da doença cardiovascular como parte integrante da estratégia.

ABSTRACT

Venous thromboembolism (VTE) is the second main cause of death of cancer patients and can be the first manifestation of neoplasms or occur at any time point of the course of the disease1-3. Subgroups have different risks with higher rates observed in specific cancers, including pancreas, stomach and multiple myeloma (MM)1.Associated with higher risk of death, thrombotic events do have an important adverse impact as they may lead to treatment interruption, increased morbidity and economic burden4. In this scenario, MM is challenging, it is the second most common hematologic cancer with a risk of VTE nine-fold higher than in the general population1,5. The high-risk results from patient, treatment and disease-related factors. The epidemiologic profile of the patient with MM favors the coexistence of additional thromboembolic risks, nevertheless, advances of oncologic treatment increased global survival and thrombotic risk4. It is known that 10% of the population with MM will develop VTE at some time point of the disease's course4,6, with high incidence in the first six months post-diagnosis5.Inconsistencies in applying the current thromboprophylaxis recommendations have been found. Due to the lack of robust data and standardized models of risk stratification, many physicians tend to rely on their clinical experience7.The ideal thromboprophylaxis of MM remains unknown