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What is your clinical threshold for treating a potential monoclonal gammopathy of thrombotic significance?

New data suggests monoclonal gammopathies can be associated with thrombotic events. Is your practice changing to include monoclonal gammopathy evaluations for new thrombosis? Or perhaps only for recurrent thrombosis or breakthrough thrombosis on therapeutic anticoagulation? For older patients who are more likely to have a monoclonal gammopathy as well as other risk factors for thrombosis, how are you deciding when a patient has a monoclonal gammopathy of thrombotic significance vs true and unrelated MGUS and thrombosis?
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When would you assess for monoclonal gammopathy of thrombotic significance?

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1 Answer
Mednet Member
Mednet MemberInvited Expert
Hematology · University of Wisconsin
Answered on

I strongly advise against routine screening for monoclonal gammopathy in patients with thrombosis. The incidence of MGUS, particularly in older patients, is relatively high and so the signal-to-noise ratio in this setting will be very low. In a patient with recurrent thrombosis and thrombocytopenia ...

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