A practical question that is particularly relevant in the long-term maintenance setting is that of thromboprophylaxis for patients receiving lenalidomide, and although almost half of the oncologists use standard-dose aspirin, both faculty use a minidose of 81 mg. Dr Munshi administers warfarin or low-molecular-weight heparin to patients at increased risk, including those with a history of deep vein thrombosis and patients who are immobile or very elderly.

Palumbo A et al. Aspirin, warfarin, or enoxaparin thromboprophylaxis in patients with multiple myeloma treated with thalidomide: A phase III, open-label, randomized trial. J Clin Oncol 2011;8(29):986-93. Abstract

Larocca A et al. Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide. Blood 2012;119(4):933. Abstract