ArticleBlood advances2022
Validation of the Khorana score for predicting venous thromboembolism in 40 218 patients with cancer initiating chemotherapy.
Article in Blood advances, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 1 of them a synthesis that pooled it.
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Who cites it
45 citing papers in PubMed, 1 synthesis or guideline pooled it, 62 citations in OpenAlex.
- Efficacy of Factor Xa Inhibitors Versus Placebo in Thromboprophylaxis for Cancer-Associated Thromboembolism: A Systematic Review and Meta-analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Preoperative Laboratory, Imaging, and Risk Assessment Before Elective Colorectal Cancer Resection: What the Clinician Must Remember.Journal of clinical medicine · 2026Review
- External validation of established clinical risk scores for cancer-associated venous thromboembolism in a Brazilian registry.Journal of thrombosis and thrombolysis · 2026Article
- Enoxaparin induces apoptosis and autophagy, modulates inflammatory signaling, and reduces oxidative DNA damage in breast and liver cancer cells.Scientific reports · 2026Article
- Coagulation disorders and thromboprophylaxis in pancreatic cancer: a review of current evidence and clinical challenges.Journal of thrombosis and thrombolysis · 2026Review
- Breast Cancer-Associated Venous Thromboembolism: Risk Factors, Mechanisms, and Clinical Management.Cancers · 2026Review
- Mechanobiology of cancer-associated thrombosis: from molecular mechanisms to therapeutic innovation.Journal of nanobiotechnology · 2026Review
- Incidence of Venous Thromboembolism in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Neoadjuvant Chemotherapy.Annals of surgical oncology · 2026Article
- Unmet Needs and Challenges in Cancer-Associated Venous Thromboembolism.International journal of molecular sciences · 2026Review
- Pulmonary origin and risk assessment of cancer-associated thrombosis.Thrombosis journal · 2026Review
- Cancer-Associated Thrombosis in Breast Cancer: Risk Factors and Personalized Management.Journal of clinical medicine · 2026Article
- Development of a predictive nomogram for perioperative lower extremity deep vein thrombosis in patients with breast cancer and the efficacy of dextran 40 prophylaxis.American journal of cancer research · 2026Article
- Plasmin Generation Kinetics Reveal a Hyperfibrinolytic Phenotype in Patients with Pancreatic Ductal Adenocarcinoma.TH open : companion journal to thrombosis and haemostasis · 2026Article
- Construction and verification of a nomogram to predict the probability of venous thromboembolism in lung cancer patients.Frontiers in molecular biosciences · 2026Article
- Development and validation of an interpretable machine learning model for venous thromboembolism risk prediction in patients with lung cancer: a real-world study.Frontiers in medicine · 2026Article
- [Lung Cancer with Pulmonary Embolism: Evidence-based Progress in Anticoagulation Assessment and Management].Zhongguo fei ai za zhi = Chinese journal of lung cancer · 2025Review
- Evaluation of nomogram prediction model for postoperative deep vein thrombosis in patients with non-small cell lung cancer.Translational cancer research · 2025Article
- Article
- Venous Thromboembolic Events in Cancer Immunotherapy: A Narrative Review.Journal of clinical medicine · 2025Review
- Validation of risk assessment models for venous thromboembolism in patients with cancer receiving systemic therapies.Blood advances · 2025Observational
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Authors and funding
11 authors at 4 institutions in 3 countries.
Funding
Abstract
The Khorana score is recommended for guiding primary venous thromboembolism (VTE) prophylaxis in cancer patients, but its clinical utility overall and across cancer types remains debatable. Also, some previous validation studies have ignored the competing risk of death, hereby potentially overestimating VTE risk. We identified ambulatory cancer patients initiating chemotherapy without other indications for anticoagulation using Danish health registries and estimated 6-month cumulative incidence of VTE stratified by Khorana levels. Analyses were conducted with and without considering death as a competing risk using the Kaplan-Meier method vs the cumulative incidence function. Analyses were performed overall and stratified by cancer types. Of 40 218 patients, 35.4% were categorized by Khorana as low risk (score 0), 53.6% as intermediate risk (score 1 to 2), and 10.9% as high risk (score ≥3). Considering competing risk of death, the corresponding 6-month risks of VTE were 1.5% (95% confidence interval [CI], 1.3-1.7), 2.8% (95% CI, 2.6-3.1), and 4.1% (95% CI, 3.5-4.7), respectively. Among patients recommended anticoagulation by guidelines (Khorana score ≥2), the 6-month risk was 3.6% (95% CI, 3.3-3.9). Kaplan-Meier analysis overestimated incidence up to 23% compared with competing risk analyses. Using the guideline-recommended threshold of ≥2, the Khorana score did not risk-stratify patients with hepatobiliary or pancreatic cancer, lung cancer, and gynecologic cancer. In conclusion, the Khorana score was able to stratify ambulatory cancer patients according to the risk of VTE, but not for all cancer types. Absolute risks varied by methodology but were lower than in key randomized trials. Thus, although certain limitations with outcome identification using administrative registries apply, the absolute benefit of implementing routine primary thromboprophylaxis in an unselected cancer population may be smaller than seen in randomized trials.
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