Khorana Risk Score for Venous Thromboembolism in Cancer Patients
Predicts risk of VTE for cancer patients depending on type of cancer and other factors.
Advice
- Use as an adjunct to clinical judgment rather than as a standalone decision-making tool.
- Although brain tumors, myeloma, and renal cancer are strongly associated with VTE, these malignancies were underrepresented in the original validation cohorts; in patients with multiple myeloma, consider using the IMPEDE-VTE tool.
Management
- Per the 2020 American Society of Clinical Oncology (ASCO) VTE prophylaxis clinical practice guidelines, outpatients with a solid malignancy should undergo risk assessment with a validated tool, such as the Khorana Risk Score, before initiation of a new chemotherapy regimen.
- In patients with a score ≥2 who do not have significant bleeding risk factors or clinically important drug interactions, the risks and benefits of thromboprophylaxis should be considered.
- Specifically, this could include apixaban, rivaroxaban, or low molecular weight heparin.
- The AVERT trial assessed apixaban 2.5 mg twice daily, while the CASSINI trial evaluated rivaroxaban 10 mg daily.