Khorana Risk Score for Venous Thromboembolism in Cancer Patients

Why Use

Predicting VTE in cancer patients is complicated and likely improved by a scoring system.

When to Use

Patients with a general cancer diagnosis (solid tumors and lymphomas) starting chemotherapy. Do not use in patients with brain tumors or myelomas.

Formula

Pearls / Pitfalls

Categorizes cancer patients for VTE risk. Higher risk cohorts (e.g. inpatients, lower performance scores) have even higher risks than shown. Most validations were completed in outpatients settings with higher risk cancer patients. Not intended to be used for diagnosis (i.e., clinical suspicion of DVT or PE) but to predict future risk of VTE (see Creator Insights for more).

Management

At least one author group has applied a binary version of the Khorana Risk Score in practice, using the result for clinical decision making.

Critical Actions

The Khorana Risk Score requires multiple laboratory variables, and it may not stratify as consistently or accurately in higher risk patients and those with cancers not indicated in the score.

Advice

The Khorana Risk Score stratifies risk well. In outpatients, VTE risk remains relatively low (~10%) even in the highest score groups.

More Information

Score interpretation Risk Group Score 2.5-month rate of VTE Low 0 0.3-0.8% Intermediate 1 - 2 1.8-2.0% High ≥3 6.7-7.1%