Risk stratification for the development of venous thromboembolism in hospitalized patients with cancer

Abstract

Introduction The Khorana score is a validated risk assessment score for estimating the risk of symptomatic venous thromboembolism (VTE) in outpatients with cancer. The objective of this study was to assess the Khorana score for predicting the development of VTE in cancer patients during hospital admission. Methods We conducted an analysis of consecutive, adult cancer patients hospitalized for medical reasons between January and June 2010 in three academic medical centers. Information on objectively diagnosed, symptomatic VTE during hospitalization, use of anticoagulant thromboprophylaxis (TP) and Khorana score variables at the time of admission was collected. Results A total of 1398 patients were included. Mean age was 62 years, 51.2% were male, and mean BMI was 25.9 kg m . The most frequent reasons for hospitalization were chemotherapy administration (22.3%), followed by pain control and palliation (21.4%). The overall incidence of VTE was 2.9% (95% CI, 2.0-3.8%), occurring in 5.4% (95% CI, 1.9-8.9%) of the high-, 3.2% (95% CI, 2.0-4.4%) of the intermediate- and 1.4% (95% CI, 0.3-2.6%), of the low-risk groups. High-risk patients were more likely than low-risk patients to have VTE (OR, 3.9; 95% CI, 1.4-11.2). Conclusion The Khorana score is predictive of in-hospital, symptomatic VTE development in cancer patients who are hospitalized for medical reasons and may be a useful tool for tailoring inpatient anticoagulant thromboprophylaxis.

Effect of heparin thromboprophylaxis on thrombin generation in multiple myeloma patients

“…Indeed, it was demonstrated that MM patients treated with immunomodulatory drugs have a higher VTE risk and higher TGT level than other patients with MM (Chalayer et al , ). Our patients with lymphoma present similar results although they do not seem to be at high VTE risk: the median Korana score, recently validated by Parker et al () in in‐hospital VTE development in cancer, was 1. Parker et al () also reported some surprising results about thromboprophylaxis.…”

“…Our patients with lymphoma present similar results although they do not seem to be at high VTE risk: the median Korana score, recently validated by Parker et al () in in‐hospital VTE development in cancer, was 1. Parker et al () also reported some surprising results about thromboprophylaxis. For example, there was no difference in VTE incidence between patients who received thromboprophylaxis and those who did not.…”

Direct oral anticoagulants for the treatment and prevention of venous thromboembolism in patients with cancer: current evidence

“…Primary thromboprophylaxis is recommended in hospitalized patients with active cancers and is not recommended in the routine care of ambulatory patients treated with chemotherapy [73,74]. This indication should be considered for select high-risk patients considering the clinical and tumor characteristics [75][76][77][78][79][80] and the clinical prediction scores, such as Khorana et al and others [77,81,82] who modify the original score, including the Protecht score [83] and Vienna score [84].…”

Risks and Benefits of Anticoagulation in Cancer and Noncancer Patients

“…26,51,52 The Khorana score, which is calculated by assessing clinical parameters, such as the site of primary tumor, hematologic parameters, and body mass index, is used to predict the risk of VTE in ambulatory outpatients with cancer but has shown validity in predicting symptomatic VTE development in hospital settings as well. 53,54 As a result, the Khorana score may be a useful tool for determining use of inpatient anticoagulant thromboprophylaxis. The benefit of inpatient thromboprophylaxis requires contemporary, cancer-specific trials and this lack of evidence needs to be recognized and prioritized by funding agencies.…”