Use of the Khorana score to predict venous thromboembolism in patients undergoing chemotherapy for uterine cancer

Piver, Rachael N; Wagner, Vincent; Levine, Melvin D.; Backes, Floor J; Chambers, Laura J; Cohn, David E; Cosgrove, Casey; Nagel, Christa; O’Malley, David M.; Bixel, Kristin

doi:10.1016/j.gore.2023.101156

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…Those patients would have potentially benefited from thromboprophylaxis. The original Khorana score 30 remains a widely known method for cancer patients receiving chemotherapy but has not been validated for many cancers and has shown poor predictability in female cancers such as ovarian 31 and endometrial cancers 32 . However, a combination with hypercoagulability marker carries potential.…”

Section: Discussionmentioning

confidence: 99%

“…However, a combination with hypercoagulability marker carries potential. Modifications of the Khorana score such as the PROTECHT have helped in the assessment of risks but the specificity is low (~52%) and the sensitivity is less than 100%, 6 but again has not shown good predictability in breast or gynecological cancers 32 . In the ROADMAP‐CAT study, several hypercoagulability markers were incorporated to improve risk assessment 33 .…”

Section: Discussionmentioning

confidence: 99%

“…25 The original Khorana score 30 remains a widely known method for cancer patients receiving chemotherapy but has not been validated for many cancers and has shown poor predictability in female cancers such as ovarian 31 and endometrial cancers. 32 However, a combination with hypercoagulability marker carries potential. Modifications of the Khorana score such as the PROTECHT have helped in the assessment of risks but the specificity is low ($52%) and the sensitivity is less than 100%, 6 but again has not shown good predictability in breast or gynecological cancers.…”

Section: Hypercoagulability By Teg Is Related To Khorana Risk Assessmentmentioning

confidence: 99%

“…Modifications of the Khorana score such as the PROTECHT have helped in the assessment of risks but the specificity is low ($52%) and the sensitivity is less than 100%, 6 but again has not shown good predictability in breast or gynecological cancers. 32 In the ROADMAP-CAT study, several hypercoagulability markers were incorporated to improve risk assessment. 33 The Vienna CAT-score, also incorporated additional procoagulant biomarkers (D-dimer and soluble P-selectin), to augment its predictive capability of the Khorana Score.…”

Section: Hypercoagulability By Teg Is Related To Khorana Risk Assessmentmentioning

confidence: 99%

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Assessing hypercoagulability and VTE risk using thromboelastography and Khorana score in women with cancers receiving chemotherapy

Tera,

Suh,

Fainchtein

et al. 2024

American J Hematol

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Venous thromboembolism (VTE) is a common occurrence in cancer and chemotherapy increases thrombosis risk. Current risk assessment models such as the Khorana score (KS) and its modifications have limitations in female cancers. We assessed the coagulation profile of a group of women cancer patients under chemotherapy using thromboelastography (TEG) to determine if this can inform VTE risk assessment. Cancer patients who planned to receive chemotherapy were recruited. Baseline demographics, cancer data, BMI, Khorana Score (KS), and VTE risk factors were recorded and patients were followed for 6 months, for any thrombotic events. A total of 36 patients aged 35–85 (18 breast, 11 endometrial, 7 ovarian cancer) were evaluated. Hypercoagulability was detected in 63% of patients post‐chemo cycle 1 and 75% post‐cycle 2, with a significant increase in MA (maximum amplitude) and CI (clotting index), reduction in R (reaction time), K (clot kinetics), and LY30 (lysis time after 30 min of MA). KS showed only 7% of patients were high risk, 23% were low, and 70% were intermediate risk. MA and CI significantly increased in patients with intermediate and high‐risk KS when compared with the low‐risk patients and MA was positively correlated with KS. Five patients developed actual VTE; 100% of the tested ones were hypercoagulable either post‐cycle 1 or 2 and 80% were KS intermediate risk. TEG is a hypercoagulability marker and TEG‐MA and CI can potentially assess VTE risk. Larger studies are needed to assess the utility of TEG as an adjuvant to KS to better predict VTE in specific female cancers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Hypercoagulability By Teg Is Related To Khorana Risk Assessmentmentioning

confidence: 99%

Section: Hypercoagulability By Teg Is Related To Khorana Risk Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Assessing hypercoagulability and VTE risk using thromboelastography and Khorana score in women with cancers receiving chemotherapy

Tera,

Suh,

Fainchtein

et al. 2024

American J Hematol

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“…Platelet count was not found significantly altered in either DVT or PE, thereby questioning the usability of this marker in the use of the Khorana score as previously reported by our study group [ 18 ]. Khorana score is designed to a mix of ambulatory cancer out-patients but seems less likely to identify VTE high-risk patients as reported in ovarian cancer and lung cancer [ 19 , 20 ], and as we have previously shown that gastroesophageal cancer and gastric cancer may have a low frequency of VTE at the time of diagnosis, but the risk seems to increase upon start of cancer treatment, especially perioperative chemotherapy [ 21 ]. This could explain the difference in frequency of VTE and the various results.…”

Section: Discussionmentioning

confidence: 99%

Monocyte recruitment in venous pulmonary embolism at time of cancer diagnosis in upper gastrointestinal cancer patients

Jakobsen,

Frøkjaer,

Fisker

et al. 2023

J Thromb Thrombolysis

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Upper gastrointestinal cancer is frequently complicated by venous thromboembolisms (VTE), especially pulmonary embolisms (PE) increase the mortality rate. Monocytes are a part of the innate immune system and up-regulation may indicate an ongoing inflammatory response or infectious disease and has lately been associated with a moderate risk of suffering from VTE. This prospectively study aims to compare the incidence of pulmonary embolism with markers of coagulation and compare it to the absolute monocyte count. A consecutive cohort of 250 patients with biopsy proven upper gastrointestinal cancer (i.e. pancreas, biliary tract, esophagus and gastric cancer) where included at the time of cancer diagnosis and before treatment. All patients underwent bilateral compression ultrasonography for detection of deep vein thrombosis (DVT). Of these 143 had an additionally pulmonary angiografi (CTPA) with the staging computer tomography. 13 of 250 patients (5.2%) had a DVT and 11 of 143 (7.7%) had CTPA proven PE. PE was significantly more common among patients with elevated D-dimer (OR 11.62, 95%CI: 1.13–119, P = 0.039) and elevated absolute monocyte count (OR 7.59, 95%CI: 1.37–41.98, P = 0.020). Only patients with pancreatic cancer had a significantly higher risk of DVT (OR 11.03, 95%CI: 1.25–97.43, P = 0.031). The sensitivity of absolute monocyte count was 63.6 (95%CI: 30.8–89.1) and specificity 80.3 (95%CI: 72.5–86.7), with a negative predictive value of 96.4 (95%CI: 91–99) in PE. An increased absolute monocyte count was detected in patients suffering from PE but not DVT, suggesting a possible interaction with the innate immune system.

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Development and validation of a predictive risk tool for VTE in women with breast cancer under chemotherapy: a cohort study in China

Xu,

Li,

Yuan

et al. 2024

Breast Cancer

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Use of the Khorana score to predict venous thromboembolism in patients undergoing chemotherapy for uterine cancer

Cited by 6 publications

References 18 publications

Assessing hypercoagulability and VTE risk using thromboelastography and Khorana score in women with cancers receiving chemotherapy

Assessing hypercoagulability and VTE risk using thromboelastography and Khorana score in women with cancers receiving chemotherapy

Monocyte recruitment in venous pulmonary embolism at time of cancer diagnosis in upper gastrointestinal cancer patients

Development and validation of a predictive risk tool for VTE in women with breast cancer under chemotherapy: a cohort study in China

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