Khorana Score (VTE risk in cancer patients starting chemotherapy)
VTE risk in ambulatory cancer patients before starting systemic chemotherapy.
Updated · Methodology
About this calculator
The Khorana score estimates VTE risk in cancer patients before chemotherapy. Developed by Khorana et al. (Blood, 2008) in 4066 patients. Five variables: cancer site (stomach/pancreas 2; lung/lymphoma/gynecologic/urinary 1), platelets >=350×10⁹/L (1), hemoglobin <100 g/L or erythropoiesis-stimulating agent use (1), leukocytes >11×10⁹/L (1), BMI >=35 (1). Maximum 6. Interpretation. 0 – low risk (2.5-month VTE rate 0.3-0.8%), no prophylaxis. 1-2 – intermediate (1.8-2%), individual decision. >=3 – high risk (6.7-7.1%), outpatient thromboprophylaxis indicated – apixaban 2.5 mg twice daily or rivaroxaban 10 mg once daily for 6 months (ASCO 2023, NCCN 2024). Clinical use. Pre-chemotherapy stratification. Decision on primary thromboprophylaxis in outpatients. Hospitalized oncology patients receive LMWH prophylaxis regardless of Khorana – inpatient admission itself is a risk factor. Clinical trials. AVERT (NEJM 2019) and CASSINI (NEJM 2019) showed reduction of symptomatic VTE with apixaban/rivaroxaban in patients with Khorana >=2 without major bleeding increase. Based on these, ASCO 2023 expanded the recommendation to Khorana >=2. Limitations. Does not capture multimodal therapy (PD-1/PD-L1 immunotherapy raises VTE risk independent of Khorana). Not validated for anti-VEGF (bevacizumab) – different recommendations apply. Does not separate primary prophylaxis from treatment of established VTE. In GI cancer, active bleeding, platelets <50×10⁹/L prophylaxis is contraindicated even with high Khorana.
Source
Formula version: khorana-2008-nccn-2024-v1