The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis

Nick van Es, Matthew Ventresca, Marcello Di Nisio, Qi Zhou, Simon Noble, Mark Crowther, Matthias Briel, David Garcia, Gary H. Lyman, Fergus Macbeth, Gareth Griffiths, Alfonso Iorio, Lawrence Mbuagbaw, Ignacio Neumann, Jan Brozek, Gordon Guyatt, Michael B. Streiff, Tejan Baldeh, Ivan D. Florez, Ozlem Gurunlu AlmaGiancarlo Agnelli, Walter Ageno, Maura Marcucci, George Bozas, Gilbert Zulian, Anthony Maraveyas, Bernard Lebeau, Ramon Lecumberri, Kostandinos Sideras, Charles Loprinzi, Robert McBane, Uwe Pelzer, Hanno Riess, Ziad Solh, James Perry, Lara A. Kahale, Patrick M. Bossuyt, Clara Klerk, Harry R. Büller, Elie A. Akl, Holger J. Schünemann

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. Objective: To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. Methods: This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. Results: A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancer patients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6; Pinteraction =.002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). Conclusion: The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.

Original languageEnglish (US)
Pages (from-to)1940-1951
Number of pages12
JournalJournal of Thrombosis and Haemostasis
Issue number8
StatePublished - Aug 1 2020


  • Khorana score
  • cancer
  • heparin
  • individual participant data meta-analysis
  • thromboprophylaxis
  • venous thromboembolism

ASJC Scopus subject areas

  • Hematology


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