(108) Evaluation of Provider Perception, Utilization, and Barriers to Incorporation of NCCN VTE Prophylaxis Recommendations for Patients with Multiple Myeloma

Poster Abstract:

Background: Patients with multiple myeloma (MM) have a nine-fold increase in risk of development of venous thromboembolism (VTE) compared to the general population. Due to this increased risk, National Comprehensive Cancer Network (NCCN) guidelines currently recommend thromboprophylaxis for all patients with MM who do not have an indication for therapeutic anticoagulation or a contraindication to VTE prophylaxis. Two risk stratification scoring systems are validated for use in patients with MM: IMPEDE and SAVED. For patients with IMPEDE score >4 or SAVED score >2, there are five recommended options for VTE prophylaxis: enoxaparin 40 mg daily, rivaroxaban 10 mg daily, apixaban 2.5 mg twice daily, fondaparinux 2.5 mg daily, and warfarin. For patients with lower IMPEDE or SAVED scores, aspirin 81-325 mg daily is recommended.

Despite these recommendations, it is estimated that a significant number of patients with MM are not prescribed an appropriate prophylactic agent. There are various reasons why patients with MM may not be on the recommended VTE prophylaxis including, but not limited to, cost, insurance factors, patient preference, and lack of use of IMPEDE and SAVED scores in clinical practice.

Objective: The purpose of this study is to describe current utilization and perception of NCCN guideline recommendations for VTE prophylaxis in MM, as well as to identify potential barriers for incorporation of recommendations into clinical practice.

Methods: This is a descriptive, electronic survey of oncology physicians, advanced practice providers, and pharmacists who see patients with MM. The survey is constructed and distributed via Qualtrics system through use of oncology provider and pharmacist listservs and social media. The survey features questions to assess provider/pharmacist practice demographics, perceptions of scoring systems and guideline recommendations, utilization of guideline recommendations, and barriers to implementation of recommended VTE prophylaxis. All survey responses are anonymous. SPSS software will be used for analysis of descriptive statistics.

The primary outcome is the percentage of participants that regularly implement NCCN guideline recommended VTE prophylaxis into their clinical practice. An additional primary outcome is the percentage of top three ranked barriers to implementation of recommended VTE prophylaxis in practice. Secondary outcomes include percentage of participants that are familiar with NCCN VTE prophylaxis recommendations, percentage of participants that feel aspirin or direct oral anticoagulants (DOACs) have higher bleed risk, and percentage of perceived risk score from significant risk to significant benefit with use of guideline recommended prophylaxis.

Results and Discussion/

Conclusions: To be presented with completed poster.

References (must also be included in final poster): 1. Kristinsson SY, Fears TR, Gridley G, et al. Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma. Blood. 2008;112(9):3582-3586.

2. Baljevic M, Sborov DW, Lim MY, et al. Optimizing thromboembolism prophylaxis for the contemporary age of multiple myeloma. Journal of the National Comprehensive Cancer Network. 2022;20(1):91-95.

3. Kumar SK, Callander NS, Adekola K, et al. NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma. Version 3.2023.

4. Sanfilippo KM, Luo S, Wang T, et al. Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score. American J Hematol. 2019;94(11):1176-1184.

5. Li A, Wu Q, Luo S, et al. Derivation and validation of a risk assessment model for immunomodulatory drug–associated thrombosis among patients with multiple myeloma. Journal of the National Comprehensive Cancer Network. 2019;17(7):840-847.

6. De Stefano V, Larocca A, Carpenedo M, et al. Thrombosis in multiple myeloma: risk stratification, antithrombotic prophylaxis, and management of acute events. A consensus-based position paper from an ad hoc expert panel. Haematol. 2022;107(11):2536-2547.