TY - JOUR
T1 - The Khorana score for prediction of venous thromboembolism in cancer patients
T2 - An individual patient data meta-analysis
AU - van Es, Nick
AU - Ventresca, Matthew
AU - Di Nisio, Marcello
AU - Zhou, Qi
AU - Noble, Simon
AU - Crowther, Mark
AU - Briel, Matthias
AU - Garcia, David
AU - Lyman, Gary H.
AU - Macbeth, Fergus
AU - Griffiths, Gareth
AU - Iorio, Alfonso
AU - Mbuagbaw, Lawrence
AU - Neumann, Ignacio
AU - Brozek, Jan
AU - Guyatt, Gordon
AU - Streiff, Michael B.
AU - Baldeh, Tejan
AU - Florez, Ivan D.
AU - Gurunlu Alma, Ozlem
AU - Agnelli, Giancarlo
AU - Ageno, Walter
AU - Marcucci, Maura
AU - Bozas, George
AU - Zulian, Gilbert
AU - Maraveyas, Anthony
AU - Lebeau, Bernard
AU - Lecumberri, Ramon
AU - Sideras, Kostandinos
AU - Loprinzi, Charles
AU - McBane, Robert
AU - Pelzer, Uwe
AU - Riess, Hanno
AU - Solh, Ziad
AU - Perry, James
AU - Kahale, Lara A.
AU - Bossuyt, Patrick M.
AU - Klerk, Clara
AU - Büller, Harry R.
AU - Akl, Elie A.
AU - Schünemann, Holger J.
N1 - Publisher Copyright:
© 2020 International Society on Thrombosis and Haemostasis
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
KW - cancer
KW - heparin
KW - individual participant data meta-analysis
KW - Khorana score
KW - thromboprophylaxis
KW - venous thromboembolism
UR - https://www.scopus.com/pages/publications/85085512295
U2 - 10.1111/jth.14824
DO - 10.1111/jth.14824
M3 - Article
C2 - 32336010
AN - SCOPUS:85085512295
SN - 1538-7933
VL - 18
SP - 1940
EP - 1951
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 8
ER -