IMPEDE-VTE Score for VTE Risk in Multiple Myeloma
IMPEDE VTE (Sanfilippo 2019) estimates the 6-month risk of venous thromboembolism after starting treatment for multiple myeloma, from nine variables: IMiD, BMI, pelvic/hip/femur fracture, ESA, doxorubicin and dexamethasone, ethnicity, VTE history, tunnelled line/CVC and existing thromboprophylaxis.
Score interpretation
6-month cumulative VTE incidence 3.3 % in the derivation cohort (Sanfilippo 2019).
→ Adults: VTE prophylaxis with aspirin 75-100 mg daily (or 150 mg daily as per some guidelines); ensure no contraindication to aspirin (peptic ulcer, bleeding history -- if so use PPI cover); counsel patient on signs of DVT/PE; reassess at each cycle or if clinical status changes; document prophylaxis decision in notes. Children: use a children's formulary.
6-month cumulative VTE incidence 8.3 % in the derivation cohort.
→ LMWH preferred over aspirin if intermediate risk with additional clinical risk factors (obesity, immobility, infection, dehydration); LMWH (adults): enoxaparin 40 mg OD SC or dalteparin 5000 units OD SC; adjust for renal impairment (creatinine clearance below 30 mL/min: reduce dose or use UFH); alternatively aspirin 150 mg daily (adults) if patient declines injection; regular monitoring of anti-Xa levels not routinely required with prophylactic dosing; counsel patient; reassess at each cycle. Children: use a children's formulary.
6-month cumulative VTE incidence 15.2 % in the derivation cohort; thromboprophylaxis is warranted.
→ LMWH prophylactic dose (adults: enoxaparin 40 mg OD SC) or consider therapeutic-dose anticoagulation if active VTE has occurred; alternatively DOAC (rivaroxaban or apixaban) if renal function adequate (creatinine clearance above 30 mL/min) and no significant drug-drug interactions with myeloma regimen; discuss choice with haematologist; duration: continue throughout IMiD therapy; if VTE occurs on prophylaxis -- upgrade to therapeutic anticoagulation (adults: LMWH 1 mg/kg BD or DOAC); thrombophilia screen if first VTE and unexpected; patient education: signs of PE (breathlessness, chest pain, haemoptysis) -- attend ED immediately. Children: use a children's formulary.
Interpretation bands for the IMPEDE-VTE. Apply clinical judgement and local guidance.
References
- Sanfilippo KM, Luo S, Wang TF, et al. Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score. Am J Hematol. 2019;94(11):1176-1184.
- Palumbo A et al. Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia. 2008;22(2):414-423.
Related
Curated clinical cross-links plus same-class fallbacks.
- Thalidomide · Immunomodulatory Drug (IMiD) — Myeloma
- Lenalidomide · Immunomodulatory Drug (IMiD)
- Thalidomide (Rheumatology / Dermatology) · Immunomodulatory Drug (IMiD)
- Lenalidomide (Specialist drug) · Immunomodulatory drug (IMiD)
- Pomalidomide (Specialist drug) · Immunomodulator (thalidomide analogue)
- Enoxaparin (LMWH) · Anticoagulant
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
