Khorana Score for VTE Risk

Stratifies VTE risk in cancer patients due to start chemotherapy.

Refer to the text below the calculator for more information on the score and its interpretation.


The Khorana score is a risk model for chemotherapy-associated thrombosis that employs clinical and biochemical characteristics in patients starting chemotherapy and classifies cancer patients in three risk groups (high, intermediate and low).

The score can be applied in patients with solid tumors and lymphomas but not in patients with brain tumors or myelomas. Identifying cancer patients at high risk of VTE may be used in guiding clinician decision-making.


Khorana Score – VTE Risk Stratification

Khorana Score Risk Group Rate of VTE at 2.5 months
≥3 High 6.7 - 7.1%
1 - 2 Intermediate 1.8 - 2.0%
0 Low 0.3 - 0.8%

1

Cancer type

2

Pre-Chemotherapy Platelet Count ≥350 x 10⁹/L

3

Hemoglobin level <10 g/dL or using RBC growth factors

4

Pre-chemotherapy leukocyte count >11x10⁹/L

5

BMI ≥35 kg/m²

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About the score

This risk model for screening the risk of chemotherapy associated venous thromboembolism was developed by Khorana et al. in 2008 (on an observational cohort of cancer patients initiating chemotherapy within the United States) and employs baseline clinical and biochemical characteristics:

■ Cancer type*;

■ Pre-Chemotherapy Platelet Count ≥350 x 10⁹/L;

■ Hemoglobin level <10 g/dL or using RBC growth factors;

■ Pre-chemotherapy leukocyte count >11x10⁹/L;

■ BMI ≥35 kg/m².

*The Khorana score can be applied in patients with solid tumors and lymphomas starting chemotherapy but not in patients with brain tumors or myelomas.

The risk score for chemotherapy-associated VTE events classifies patients into low, intermediate, and high risk groups:

Khorana Score Risk Group Rate of VTE at 2.5 months
≥3 High 6.7 - 7.1%
1 - 2 Intermediate 1.8 - 2.0%
0 Low 0.3 - 0.8%

This is not a VTE, DVT or PE diagnosis tool but a risk stratification tool for future risk of VTE. Most subsequent validations of the score were completed in outpatient settings with higher risk cancer patients.

 

References

Original reference

Khorana AA, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111:4902-7.

Validation

Dutia M, et al. Risk Assessment Models for Cancer-Associated Venous Thromboembolism. Cancer 2012; 118:3468-76.

Other references

Lyman GH, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jun 10;31(17):2189-204. doi: 10.1200/JCO.2013.49.1118. Epub 2013 May 13.

Khorana AA, Soff GA, Kakkar AK, et al. Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer. N Engl J Med. 2019; 380(8):720-728.


Specialty: Preventive Medicine

Objective: Risk Predictor

Type: Score

No. Of Items: 5

Year Of Study: 2008

Article By: Denise Nedea

Published On: April 10, 2020

Last Checked: April 10, 2020

Next Review: April 10, 2025