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 - Funding Information:
This project is funded by a Knowledge Synthesis grant awarded by the Canadian Institutes for Health Research (grant KRS 126594) to HJS. The Canadian Institutes for Health Research had no role in the design, analysis or interpretation phases of this investigation.
Funding Information:
This project is funded by a Knowledge Synthesis grant awarded by the Canadian Institutes for Health Research (grant KRS 126594) to HJS. The Canadian Institutes for Health Research had no role in the design, analysis or interpretation phases of this investigation. The authors thank the research organizations and authors responsible for sharing primary clinical trial data: Sanofi, Novartis Pharma GmbH, Instituto Cient?fico y Tecnol?gico, University of Navarra, Velindre National Health Service Trust, Charit??Universit?tsmedizin Berlin, and Sunnybrook Health Sciences Centre.
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 - Khorana score
KW - cancer
KW - heparin
KW - individual participant data meta-analysis
KW - thromboprophylaxis
KW - venous thromboembolism
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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 -