Patients with MM have a high baseline incidence of thrombotic complications—perhaps as high as 10%.156 Treatment with either thalidomide or lenalidomide in combination with either glucocorticoids69, 70 157 158 or chemotherapy111, 112, 159 appears to increase this risk.

All MM patients receiving these IMiD-containing combinations should receive some form of thromboprophylaxis. There is evidence to support the use of full-dose warfarin,69 prophylactic dose enoxaparin,107 and aspirin (ASA) 81-325 mg daily.122, 159< 158 These preven-tative agents have not been compared head-to-head. The favorable cost- and toxicity-profile of ASA has made this the most attractive option for patients and clinicians, though some experts have advocated full-dose warfarin or enoxaparin as preferred options.160

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