Khorana Score for VTE Risk in Cancer Patients
A validated risk score predicting venous thromboembolism (VTE) in ambulatory cancer patients starting chemotherapy. Score ranges from 0-7.
Warnings:
- Developed in ambulatory cancer patients before starting chemotherapy
- Score 0 was validated for VTE risk with direct oral anticoagulants in the CASSINI and AVERT trials
- FDA approved apixaban and rivaroxaban for Khorana >=2 in high-risk cancer patients
- VTE rates in different cancer types vary: gastric/pancreatic ~12.9%; lung/lymphoma ~6-8%; breast/colorectal ~1.5-2%
- Does not predict VTE in patients already on anticoagulation
- A modified version (CATS score) uses only platelet, leukocyte, and site with AUC 0.60
- Use clinical judgment alongside score for thromboprophylaxis decisions
Note: Maximum score = 7. Validation data: Score 0 = 1.5% VTE rate; Score 1 = ~1.5%; Score 2 = ~4-5%; Score >=3 = 7.2-12.9%. Note: Score 0 and 1 are both low risk, but score 0 patients had VTE rates in CASSINI trial supporting prophylaxis consideration at threshold >=2.
Site of primary cancer based on thrombosis risk category
Pre-chemotherapy platelet count
Pre-chemotherapy hemoglobin or current erythropoiesis-stimulating agent use
Pre-chemotherapy leukocyte count
Body mass index
References
- Development and validation of a predictive model for chemotherapy-associated thrombosis - Blood (Khorana AA et al.) (2008)
- Khorana Score for Venous Thromboembolism (VTE) - MDCalc - MDCalc (2020)
Medical Disclaimer
This calculator is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.