Preventing blood clots if you have myeloma

A blood clot, also called venous thromboembolism (VTE), is a blockage in a deep vein in your body.

Blood clots usually form in a deep vein in the leg, but they can also occur in other areas, such as the arms. This is called a deep vein thrombosis (DVT).

Sometimes, a piece of clot can break off, travel to your lungs through your bloodstream, and can block a blood vessel there. This is called a pulmonary embolism (PE) and can be life-threatening.

If you think you may have a blood clot, you will need urgent treatment. Go to your nearest Emergency Department (A&E) as soon as possible.

People with myeloma are more likely to develop a blood clot than people who do not have myeloma. This risk is highest at diagnosis and when starting chemotherapy.

Not everyone with myeloma has the same chance of developing a blood clot. Some people are more likely than others, depending on their situation. Your hospital doctor will consider your circumstances to assess your own risk of developing a blood clot. If you are worried about your risk (for example, if you or a family member has had one before), please tell your doctor.

There are steps you can take to help lower your risk of a blood clot, including:

• staying as active as you can during your treatment
• drinking plenty of water to avoid dehydration

Depending on your individual assessment, your doctor may also recommend:

• a low dose of aspirin, or
• a ‘blood-thinning’ medicine (anticoagulant), if your risk of a blood clot is higher

Your doctor will explain why they recommend a specific medicine for you and answer any questions you may have. Once your risk of a blood clot has reduced, your doctor may stop the medicine. This often happens when chemotherapy finishes.

Apixaban tablets

Apixaban is taken twice a day, about 12 hours apart. For example, you can take it at 8am (in the morning) and 8pm (in the evening).

Apixaban is often used to reduce the risk of blood clots after joint replacement surgery. Studies have also shown that it helps to lower the risk of blood clots in people with cancer. There has not been a study looking specifically at people with myeloma. However, people with myeloma took part in these studies along with those who had other types of cancer.

Enoxaparin injections

If apixaban is not suitable for you, your doctor may recommend an injection called enoxaparin instead. For some patients with myeloma, this is still the preferred option.

Enoxaparin is usually self-administered and taken once a day under the skin (subcutaneously). We will show you and your carer how to do the injections. We will also give you a sharps bin for used syringes. When the bin is nearly full, close the lid until it is sealed, fill in the label on the side, and return the bin to UCLH at your next appointment. You can find full instructions on the side of your sharps bin. Do not throw syringes or sharps bins in household waste.

Please note that enoxaparin is of animal origin. If you have concerns about this, please speak to your doctor.

Like all medicines, blood thinners may have potential side effects. The most common are mild bleeding or bruising, but most people do not have any problems.

Experience shows that apixaban does not increase the risk of bleeding when compared with aspirin or enoxaparin.

Contact your GP or go to the nearest Emergency Department (A&E) straight away if you notice:

• blood in your urine or stools
• severe or unexplained bruising
• bleeding that does not stop
• coughing up blood
• any other unusual bleeding

You should also go to the nearest Emergency Department (A&E) if you have had a head injury, even if you do not lose consciousness.

• Your GP can prescribe aspirin once this has been recommended by your hospital doctor.
• Your hospital doctor will prescribe enoxaparin or apixaban. You can then collect your hospital-prescribed medicine from Rowlands pharmacy at UCLH.
• We will let your GP know about any blood-thinning medicine or aspirin that you are taking.

If you have any general questions about blood thinners or clot prevention, please contact your myeloma CNS or pharmacist in the first instance.

If you have a printed version of this information, you can write your CNS’s details in the space below:

Name: ..............................................................................................................................

Tel: .................................................................................................................................

Switchboard: 020 3456 7890

NHS website:

DVT (deep vein thrombosis)

Pulmonary embolism

Cancer Research UK:

Cancer and the risk of blood clots