IMPEDE-VTE
Predicts risk of venous thromboembolism in multiple myeloma
Jennifer Glen
Provided by
EVAL FoundationIn patients with multiple myeloma (MM), venous thromboembolism (VTE) is a common cause of morbidity and mortality. The Myeloma Working Group (IMWG) developed and validated a risk prediction score to quantify risk of VTE in patients with MM starting chemotherapy (Sanfilippo et al., 2019). The IMPEDE-VTE score comprises the following nine variables: Immunomodulatory drugs (IMDs); Body Mass Index (BMI); Pelvic, hip or femur fracture; use of Erythropoiesis-stimulating agents (ESAs); use of Dexamethasone/Doxorubicin; Ethnicity/Race; VTE history; Tunneled line/CVC; and Existing thromboprophylaxis. The IMEPDE-VTE score outperformed the risk stratification in the IMWG/NCCN guidelines. Sanfilippo et al. (2019) suggest, "Risk assessment can help clinicians select thromboprophylaxis in high-risk patients, and avoid anticoagulants in those at low VTE risk. These data suggest that the IMPEDE VTE score could replace the risk stratification within the current guidelines for identification of patients with MM at high risk of VTE."
.Summary
VTE The Myeloma Working Group (IMWG) developed and validated a risk prediction score to quantify risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM) starting chemotherapy (Sanfilippo et al., 2019).
The IMPEDE-VTE score comprises the following nine variables: Immunomodulatory drugs (IMDs); Body Mass Index (BMI); Pelvic, hip or femur fracture; use of Erythropoiesis-stimulating agents (ESAs); use of Dexamethasone/Doxorubicin; Ethnicity/Race; VTE history; Tunneled line/CVC; and Existing thromboprophylaxis.
Scoring and Recommendations
The IMPEDE-VTE Score is calculated by the addition of the selected points.
| Variable | Points |
| Use of Immunomodulatory drugs (IMDs) | No 0 Yes 4 |
| Body Mass Index (BMI) ≥ 25 kg/m² | No 0 Yes 4 |
| Pelvic, hip or femur fracture | No 0 Yes 1 |
| Erythropoiesis-stimulating agents (ESAs) | No 0 Yes 1 |
| Dexamethasone use | No 0 Low dose 2 High dose 4 |
| Doxorubicin use | No 0 Yes 3 |
| Ethnicity/Race is Asian or Pacific Islander | No -3 Yes 0 |
| History of VTE before multiple myeloma | No 0 Yes 5 |
| Tunneled line or central venous catheter | No 0 Yes 2 |
| Existing thromboprophylaxis: i.e. therapeutic LMWH* or warfarin use | No 0 Yes -4 |
| Existing thromboprophylaxis: i.e. therapeutic LMWH or aspirin use | No 0 Yes -3 |
*LMWH: Low molecular weight heparin
| IMPEDE-VTE Score | Result |
| ≤ 3 | Low Risk of VTE within 6 months of treatment initiation. |
| 4-7 | Intermediate Risk of VTE within 6 months of treatment initiation. |
| ≥ 8 | High Risk of VTE within 6 months of treatment initiation. |
| ≥ 4 | Consider VTE prophylaxis in high risk patients
|
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All questions & possible results
Section OneTitle not visible
BMI ≥ 25 kg/m²
Select one option:
- No
- Yes
- Help me calculate BMI
Section TwoTitle not visible
BMI ≥ 25 kg/m² (Results from the BMI Calculator)
Select one option:
- No
- Yes
Immunomodulatory drug use
Select one option:
- No
- Yes
Pelvic, hip or femur fracture
Select one option:
- No
- Yes
Erythropoiesis-stimulating agent
Select one option:
- No
- Yes
Doxorubicin use
Select one option:
- No
- Yes
Dexamethasone use
Select one option:
- No
- Low dose
- High dose
Ethnicity (race) is Asian or Pacific Islander
Select one option:
- No
- Yes
History of venous thromboembolism (VTE) before multiple myeloma
Select one option:
- No
- Yes
Tunneled line or central venous catheter
Select one option:
- No
- Yes
Existing thromboprophylaxis (i.e. therapeutic LMWH or warfarin use)
low molecular weight heparin (LMWH)
Select one option:
- No
- Yes
Existing thromboprophylaxis (i.e. therapeutic LMWH or aspirin use)
Select one option:
- No
- Yes
Default SectionTitle not visible
Weight
A number between 0 and 800, in kg or lbs.
Height
A number between 0 and 200, in cm or in.
Target BMI
A number between 2 and 60, in kg/m².
Possible results
IMPEDE-VTE Score: Intermediate Risk (4-7 pts)
Intermediate Risk of VTE within 6 months of treatment initiation.
IMPEDE-VTE Score: Low Risk ( ≤ 3 pts)
Low Risk of VTE within 6 months of treatment initiation.
Consider VTE prophylaxis in high risk patients
The 2022 NCCN Guidelines suggest a cutoff of ≥ 4 as high risk.
The primary and validation research of the IMPEDE-VTE score suggest a cutoff of ≥ 8 as high risk.
Follow the standard of care for your practice.
IMPEDE-VTE Score: High Risk (8-24 pts)
High Risk of VTE within 6 months of treatment initiation.
Target Weight for BMI Target
Target Weight for BMI Target
Body Mass Index
BMI may be a simple and cost-effective measure of body fat. BMI evaluates the relationship of body mass to height, but it may not be accurate for everyone. BMI does not differentiate between the ratio of body fat to muscle present in body mass nor factor gender, developmental or ethnic considerations. Examples of BMI Limitations:
- May be an inappropriate measure for muscular or fit body types. Body fat measurements may be more accurate.
- Ethnic variations in height and stature.
Literature
- Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score. Am J Hematol. 2019 Nov;94(11):1176-1184. — Sanfilippo KM, Luo S, Wang TF, Fiala M, Schoen M, Wildes TM, Mikhael J, Kuderer NM, Calverley DC, Keller J, Thomas T, Carson KR, Gage BF.
- Validation of the IMPEDE VTE score for prediction of venous thromboembolism in multiple myeloma: a retrospective cohort study. Br J Haematol. 2021 Jun;193(6):1213-1219. — Covut F, Ahmed R, Chawla S, Ricaurte F, Samaras CJ, Anwer F, Garcia AVM, Angelini DE, Mazzoni S, Faiman B, Valent J, Khouri J.
