Wednesday, September 1, 2021

Khorana score

 Q: According to Khorana score which organ cancer has the highest risk of venous thromboembolism (VTE)? 

A) Stomach

B) Lung

C) Lymphoma

D) Gynecologic tumors 

E) Testicular 


Khorana score was developed by Dr. Alok A. Khorana at the Cleveland Clinic and was first published in 2008. It estimates the risk of VTE in cancer patients. It is a validated score and has been re-tested with subsequent trials. It takes into account five factors to determine the risk of VTE 

  • Site of the primary tumor 
  • Pre-chemotherapy platelet count 
  • Hemoglobin level 
  • Pre-chemotherapy WBC count 
  • BMI 

In Khorana score stomach and pancreas cancers were found to have the highest risk of VTE. Said that patients with brain tumors and myeloma were excluded from the trial published in 2008. 

Khorana score is available via various search engines.  Later on, CASSINI and AVERT trials looked into thromboprophylaxis in cancer patients.  




1. Khorana AA, Kuderer NM, Culakova E, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111:4902. 

2. Ay C, Dunkler D, Marosi C, et al. Prediction of venous thromboembolism in cancer patients. Blood 2010; 116:5377. 

3. Mandala M, Clerici M, Corradino I, et al. Incidence, risk factors and clinical implications of venous thromboembolism in cancer patients treated within the context of phase I studies: the 'SENDO experience'. Ann Oncol 2012; 23:1416.

4. Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J. A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial. Health Technol Assess. 2017 Sep;21(54):1-120. doi: 10.3310/hta21540. PMID: 28967376; PMCID: PMC5641820.

5. Khorana AA, Soff GA, Kakkar AK, Vadhan-Raj S, Riess H, Wun T, Streiff MB, Garcia DA, Liebman HA, Belani CP, O'Reilly EM, Patel JN, Yimer HA, Wildgoose P, Burton P, Vijapurkar U, Kaul S, Eikelboom J, McBane R, Bauer KA, Kuderer NM, Lyman GH; CASSINI Investigators. Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer. N Engl J Med. 2019 Feb 21;380(8):720-728. doi: 10.1056/NEJMoa1814630. PMID: 30786186.

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