Khorana Risk Score for Venous Thromboembolism in Cancer Patients predicts risk of VTE for cancer patients depending on type of cancer and other factors.

This score system available to use in general cancer patients starting chemotherapy (i.e., solid tumors and lymphomas).

Please, note!

• Do not use this score system in patients with brain tumors or myelomas.
• The assessment based on this scale not intended to be used for diagnosis (i.e., clinical suspicion of DVT or PE) but to predict future risk of VTE.

Based on Khorana Risk Score for Venous Thromboembolism cancer patients categorizes on the VTE risk.

Most validations of Khorana Risk Score for Venous were completed in outpatients settings with higher risk cancer patients.

Predicting VTE in cancer patients is complicated and likely improved by a scoring system.

Score interpretation

Addition of selected points.

If high, the clinician seeing the patient is alerted, and a lower extremity ultrasound for early detection of DVT is suggested.

The main goal of Khorana Risk Score for Venous Thromboembolism in Cancer Patients is to improve understanding of risk prediction and to focus on at-risk patients with strategies for early detection or prophylaxis.

Literature:
Khorana AA, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-7 (https://ashpublications.org/blood/article/111/10/4902/24209/Development-and-validation-of-a-predictive-model )
Dutia M, et al. Risk Assessment Models for Cancer-Associated Venous Thromboembolism. Cancer 2012;118:3468-76 (https://pubmed.ncbi.nlm.nih.gov/22086826/)
Lyman GH, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jun 10;31(17):2189-204. doi: 10.1200/JCO.2013.49.1118. Epub 2013 May 13 (https://pubmed.ncbi.nlm.nih.gov/25873061/)
Khorana AA, Soff GA, Kakkar AK, et al. Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer. N Engl J Med. 2019;380(8):720-728 (https://www.nejm.org/doi/full/10.1056/NEJMoa1814630) Carrier M, Abou-nassar K, Mallick R, et al. Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med. 2019;380(8):711-719 (https://www.nejm.org/doi/full/10.1056/NEJMoa1814468)

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Charlson Comorbidity Index (CCI) Online Calculator

May 10, 2023

Charlson Comorbidity Index predicts 10-year survival in patients with multiple comorbidities.

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Age *

<50 years

50–59 years

60–69 years

70–79 years

≥80 years

Myocardial infarction *

History of definite or probable MI (EKG changes and/or enzyme changes)

No

Yes

Congestive heart failure *

Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agents

No

Yes

Peripheral vascular disease *

Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)

No

Yes

Cerebrovascular accident or Transient ischemic attack *

History of a cerebrovascular accident with minor or no residua and transient ischemic attacks

No

Yes

Dementia *

Chronic cognitive deficit

No

Yes

Chronic obstructive pulmonary disease *

No

Yes

Connective tissue disease *

No

Yes

Peptic ulcer disease *

Any history of treatment for ulcer disease or history of ulcer bleeding

No

Yes

Liver disease *

Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history, mild = chronic hepatitis (or cirrhosis without portal hypertension)

None

Mild

Moderate to severe

Diabetes mellitus *

None or diet-controlled

Uncomplicated

End-organ damage

Hemiplegia *

No

Yes

Moderate to severe chronic kidney disease *

Severe = on dialysis, status post kidney transplant, uremia, moderate = creatinine >3 mg/dL (0.27 mmol/L)

No

Yes

Solid tumor *

None

Localized

Metastatic

Leukemia *

No

Yes

Lymphoma *

No

Yes

AIDS *

No

Yes

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Charlson Comorbidity Index

10-year survival

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February 5, 2023

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≥1 of the following (A or B)

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A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

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Result

Diagnostic result Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result Positive for multiple myeloma by IMWG criteria

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