A systematic review of the incidence of venous thromboembolism (VTE) and effectiveness of prophylaxis in patients with multiple myeloma (MM) receiving thalidomide
Bibliographic record
Abstract
9056 Background: Thalidomide (T) is effective for treating MM but is associated with an increased incidence of VTE, especially when combined with other agents. Consequently, prophylaxis in patients receiving T-containing regimens has been recommended. However, the true risk of VTE is uncertain and the effectiveness of prophylaxis has not been established. We performed a systematic review to determine the incidence of VTE and the effect of prophylaxis in MM patients receiving T-containing regimens. Methods: MEDLINE and EMBASE were searched from 1966 to 11/16/2006. Only randomized controlled trials (RCT) and prospective cohort studies (PC) were included. Studies evaluating post-transplant maintenance therapy were excluded. Both authors independently screened and reviewed identified publications, and extracted data of pre-specified variables. Incidence estimates were calculated as proportions along with 95% CI. Results: 363 papers were identified but only 80 were relevant and reviewed. 45 studies (6 RCT and 39 PC) involving 1,886 patients receiving T-containing regimens met inclusion criteria. 9 studies clearly stated objective testing was used to confirm a diagnosis of VTE. The incidence of VTE is summarized in the table . We found 12 trials that used prophylaxis. None included appropriate control groups to allow assessment of effectiveness. Based on limited data, the incidences of VTE with prophylaxis were: ASA 13.9% (95% CI 9.1–19.9%), fixed low- dose warfarin 21.9% (95% CI 16.9–27.5%), therapeutic-dose warfarin 0% (95% CI 0–5.5%), and low molecular weight heparin 13.3% (95% CI 10.5- 16.6%). Conclusions: The incidence of VTE in MM patients receiving T-containing regimens ranges from 3% to 22%, depending on the patient type and agents used. Given the lack of level I/II evidence, recommendation for routine prophylaxis for patients receiving T- containing regimens is premature. A safe and effective antithrombotic regimen has yet to be identified. [Table: see text] No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.042 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.008 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".