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Khorana Risk Score for Venous Thromboembolism in Cancer Patients

Khorana risk score is quick and efficient tool used for assessing the occurrence of venous thromboembolism (VTE) associated with various types of cancer.
Cancer type
Stomach 2
Pancreas 2
Lung 1
Lymphoma 1
Gynecologic 1
Bladder 1
Testicular 1
Other 0
Pre-chemotherapy platelet count ≥350x10⁹/L
No 0
Yes 1
Hemoglobin level <10 g/dL or using RBC growth factors
No 0
Yes 1
Pre-chemotherapy leukocyte count ≥11x10⁹/L
No 0
Yes 1
BMI ≥35 kg/m²
No 0
Yes 1


Measured Factor
Venous thromboembolism
Measured Factor Disease
  • Venous thromboembolism
Measured Factor Detail
Khorana risk factor is helpful in assessing the risk of VTE associated in patients with various types of cancer. The occurence of VTE in cancer patients is high so with this scale risk of VTE can be minimised by providing targeted therapy for VTE occurence.
Body System
Multiple body systems
Measured Factor Low Impact
  • A score of 0 indicates low risk rate of VTE at 2.5 months with 0.3-0.8%.
Measured Factor High Impact
  • Maximum score of 5 indicates high risk rate of VTE at 2.5 month with 6.7-7.1%.

Result Interpretation

Ranges Ranges
  • Critical High: 500%
  • Normal: 0
  • Normal Adult Male: 0%
  • Normal Adult Female: 0%
  • Normal Pediatric: 0
  • Normal Neonate Female: 0
  • Normal Geriatric Male: 0%
  • Normal Geriatric Female: 0%
Result High Conditions
  • Venous thromboembolism
Test Limitations
This model assigns the same risk score to all patients with cancer thus not able to distinguish between any features such as the primary site, stage, or active treatment.
References: 2


Study Validation 1
The aim of this prospective observational study was to develop the model for predicting chemotherapy-associated venous thromboembolism (VTE) using baseline clinical and laboratory variables. Study was conducted on population of 2701 patients suffering from cancer. The primary outcomes identified were site of cancer, platelet count, hemoglobin levels and/or use of erythropoiesis-stimulating agents, leukocyte count and body mass index. Based on the severity of above variables final scores was obtained and rates of VTE in patients were evaluated using multivariate model. Patients were stratified into 3 groups based on their score: low-risk (score = 0), intermediate-risk (score = 1-2) and high-risk (score >/= 3). This study showed that by utilizing Khorana model patients can be identified with short term risk of symptomatic VTE.
References: 3
Study Validation 2
This retrospective study was conducted to test the performance of Khorana model at predicting risk of venous thromboembolism (VTE) in patients with metastatic cancer. Data were collected from 112 outpatients with solid tumors or malignant lymphoma who had undergone active chemotherapy in the last two years. The predictive variables included in this model were site of cancer, platelet count of 350 × 109/L or more, hemoglobin less than 100g/L and or/use of erythropoiesis-stimulating agents; leukocyte count more than 11 × 109/L and body mass index of 35kg/m2 or more (1 point each). Patients were stratified into 3 groups based on their score: low-risk (score = 0), intermediate-risk (score = 1-2) and high-risk (score >/= 3). Results showed that there were 20 low risk patients, 63 intermediate risk and 29 high risk. 23 patients experience VTE mostly from high risk group. A strong correlation between overall mortality and a higher risk score was seen in the study. This study validates the Khorana model to predict VTE  and survival rates in cancer patients
References: 4
Study Validation 3
This retrospective study was aimed to validate the Khorana Risk Score (KRS) ) in the prediction of VTE among patients with lung cancer. A total 719 patients with non-small lung cancer were included in the study for review process. The correlation between KRS and the risk of VTE was studied using cumulative incidence function with competing risk models. Prediction of mortality was considered as secondary outcome. Patients were categorized according to the KRS scores. Results showed that a high KRS (cumulative incidence, 12.4%; 95% confidence interval [CI], 6.4-20.5%) was not associated with VTE compared with an intermediate score (cumulative incidence, 12.1%; 95% confidence interval, 9.5-15.0%) in both univariate and multivariable analyses. This study concluded that KRS was not able to quantify patients with lung cancer who are at the highest risk of VTE suggesting that there is unmet need for improved risk stratification methods for this subgroup of patients.
References: 5
Study Additional 1
The purpose of this observational study was to predict the risk of venous thromboembolism (VTE) by identifying tumor site. 345 active cancer patients who had incident of VTE were observed in the study. State Surveillance, Epidemiology, and End Results (SEER) data was used to predict prevalence of cancer by cancer site for all VTE cases. The primary outcome measure was standardized Morbidity Ratios (SMR) which was evaluated for each cancer site by dividing the observed number of cancers in the VTE incident cohort with the expected number. Results of this study showed that patients with VTE, all cancer sites had an increased SMR. In women SMR for breast, ovarian and other gynecologic cancers were 8.4, 13.0 and 8.4, respectively; for men, prostate cancer SMR was 7.9.The relative risk (RR) of cancer in VTE cases was associated with cancer site in a multivariable model suggesting that Incident VTE risk can be predicted by cancer site.
References: 6
Study Additional 2
This retrospective study was planned to find out the incidence of venous thromboembolic events (VTE) in patients with glioblastoma (GB) who are undergoing first-line chemo radiotherapy. Using this data, study was aimed to develop a clinical score which could help the clinicians identify those glioblastoma patients who are at the highest risk of VTE. 115 patients with GB cancer were recruited in the study and a predictive value for VTE was assessed in all patients by comparing logistic models and area under the receiver operating characteristic curve. Scores were given based on evaluating following parameters: Karnofsky performance status (KPS), Age, Current smoking and Hypertension. Patients with more than 3 points were 5 times more prone to develop a VTE. This study concluded that Khorana scoring system can identify GB patients who are at high risk of developing VTE but further validation studies are required.
References: 7
Study Additional 3
This study was aimed to develop risk score calculator which could predict the incidences of recurrent Venous thromboembolism (VTE) within 3 years after first-time VTE occurred. 2989 patients with an acute first-time pulmonary embolism and/or lower-extremity deep vein thrombosis were involved in the study. Mean age of patients was 64.3 years. The cumulative incidence rate of recurrent VTE within 3 years was 15% overall. Risk score was assigned to each individual and using multivariable regression recurrent rate was evaluated. This study concluded that Khorana risk calculator may assist clinicians at the index encounter in determining the recurrent rate of VTE during acute treatment phase of cancer
References: 8


  1. Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902-7.
  2. Dutia M, White RH, Wun T. Risk assessment models for cancer-associated venous thromboembolism. Cancer. 2012;118(14):3468-76.
  3. Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111(10):4902-7
  4. Kearney JC, Rossi S, Glinert, K and Henry DH. "Venous Thromboembolism (VTE) and Survival in a Cancer Chemotherapy Outpatient Clinic: A Retrospective Chart Review Validation of a VTE Predictive Model." (2009): 2503-2503.
  5. Mansfield AS, Tafur AJ, Wang CE, Kourelis TV, Wysokinska EM, Yang P. Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer. J Thromb Haemost. 2016;14(9):1773-8.
  6. Petterson TM, Marks RS, Ashrani AA, Bailey KR, Heit JA. Risk of site-specific cancer in incident venous thromboembolism: a population-based study. Thromb Res. 2015;135(3):472-8.
  7. Lim G, Ho C, Roldan urgoti G, Leugner D, Easaw J. Risk of Venous Thromboembolism in Glioblastoma Patients. Cureus. 2018;10(5):e2678.
  8. Huang W, Goldberg RJ, Anderson FA, Cohen AT, Spencer FA. Occurrence and predictors of recurrence after a first episode of acute venous thromboembolism: population-based Worcester Venous Thromboembolism Study. J Thromb Thrombolysis. 2016;41(3):525-38.

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