Journal article
The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis.
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van Es N
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
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Ventresca M
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Di Nisio M
Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy.
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Zhou Q
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Noble S
Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK.
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Crowther M
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Briel M
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Garcia D
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Lyman GH
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Macbeth F
Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK.
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Griffiths G
Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK.
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Iorio A
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Mbuagbaw L
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
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Neumann I
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Brozek J
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Guyatt G
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Streiff MB
Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Baldeh T
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Florez ID
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Gurunlu Alma O
Department of Statistics, Mugla Sitki Kocman University, Mugla, Turkey.
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Agnelli G
Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy.
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Ageno W
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Marcucci M
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Bozas G
Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Cottingham, UK.
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Zulian G
Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Maraveyas A
Division of Cancer-Hull York Medical School, University of Hull, Hull, UK.
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Lebeau B
Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
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Lecumberri R
Hematology Service, University Clinic of Navarra, Pamplona, Spain.
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Sideras K
Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA.
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Loprinzi C
Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA.
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McBane R
Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA.
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Pelzer U
Division of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt Universität-Universität zu Berlin, Berlin, Germany.
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Riess H
Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany.
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Solh Z
Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Perry J
Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada.
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Kahale LA
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Bossuyt PM
Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands.
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Klerk C
Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands.
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Büller HR
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
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Akl EA
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Schünemann HJ
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Published in:
- Journal of thrombosis and haemostasis : JTH. - 2020
English
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.
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Language
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Open access status
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closed
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Persistent URL
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https://sonar.ch/global/documents/81603
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