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.
To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of LMWH among high-risk Khorana score patients.
This individual patient data meta-analysis evaluated (ultra)-low-molecular-weight heparin (LMWH) in patients with solid cancer using data from seven randomized controlled trials.
A total of 3,293 patients from the control groups with an available Khorana score had lung (n=1,913; 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 (OR 1.6; 95%-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 =0.002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared to 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).
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 3-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.
Journal of thrombosis and haemostasis : JTH. 2020 Apr 26 [Epub ahead of print]
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, Mbuagbaw Lawrence, Ignacio Neumann, Jan Brozek, Gordon Guyatt, Michael B Streiff, Tejan Baldeh, Ivan D Florez, Ozlem Gurunlu Alma, Giancarlo 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, IPDMA heparin use in cancer patients research group
Department of Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands., Michael G. DeGroote Cochrane Canada and McGRADE centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada., Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy., Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK., Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA., Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK., Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Department of Statistics, Mugla Sitki Kocman University, Mugla, Turkey., Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy., Department of Medicine and Surgery, University of Insubria, Varese, Italy., Academic Department of Medical Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK., Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Switzerland., Division of Cancer-Hull York Medical School, University of Hull, Hull, UK., Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France., Hematology Service, University Clinic of Navarra, Pamplona, Spain., Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, Minnesota, USA., Division of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität - Universität zu Berlin, Berlin Institute of Health, Berlin, Germany., Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany., Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Division of Neurology, Sunnybrook Health Science Centre, Toronto; Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, Canada., Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands., Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands.