Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide

Alessandra Larocca, Federica Cavallo, Sara Bringhen, Francesco Di Raimondo, Anna Falanga, Andrea Evangelista, Maide Cavalli, Anfisa Stanevsky, Paolo Corradini, Sara Pezzatti, Francesca Patriarca, Michele Cavo, Jacopo Peccatori, Lucio Catalano, Angelo Michele Carella, Anna Maria Cafro, Agostina Siniscalchi, Claudia Crippa, Maria Teresa Petrucci, Dina Ben YehudaEloise Beggiato, Tommaso Caravita Di Toritto, Mario Boccadoro, Arnon Nagler, Antonio Palumbo*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

250 Scopus citations


Lenalidomide plus dexamethasone is effective in the treatment of multiple myeloma (MM) but is associated with an increased risk of venous thromboembolism (VTE). This prospective, open-label, randomized substudy of a phase 3 trial compared the efficacy and safety of thromboprophylaxis with low-dose aspirin (ASA) or low-molecular-weight heparin (LMWH) in patients with newly diagnosed MM, treated with lenalidomide and low-dose dexamethasone induction and melphalan-prednisone-lenalidomide consolidation. Overall, 342 patients who did not have clinical indications or contraindications to antiplatelet or anticoagulant therapy were randomly assigned to receive ASA 100 mg/d (n = 176) or LMWH enoxaparin 40 mg/d (n = 166). The incidence of VTE was 2.27% in the ASA group and 1.20% in the LMWH group. Compared with LMWH, the absolute difference in the proportion of VTE was 1.07% (95% confidence interval, -1.69-3.83; P = .452) in the ASA group. Pulmonary embolism was observed in 1.70% of patients in the ASA group and none in the LMWH group. No arterial thrombosis, acute cardiovascular events, or sudden deaths were reported. No major hemorrhagic complications were reported. In previously untreated patients with MM receiving lenalidomide with a low thromboembolic risk, ASA could be an effective and less-expensive alternative to LMWH thromboprophylaxis. This study was registered at as #NCT00551928.

Original languageAmerican English
Pages (from-to)933-939
Number of pages7
Issue number4
StatePublished - 26 Jan 2012
Externally publishedYes

Bibliographical note

Funding Information:
1This research is supported in part by an Intel Ph.D. Research Fellowship, by Microsoft (Award #024263), by Intel (Award #024894), and by matching fund from U.C. Discovery (Award #DIG07-10227).


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