What is the Khorana Score?
The
Khorana Score is a clinical prediction tool used to estimate the risk of venous thromboembolism (VTE) in patients undergoing chemotherapy for cancer. It was developed by Dr. Alok Khorana and his colleagues to help identify patients at high risk for developing blood clots, so that preventative measures can be taken.
Site of cancer: Very high-risk sites (stomach, pancreas) are assigned 2 points, high-risk sites (lung, lymphoma, gynecologic, bladder, testicular) are assigned 1 point, and others are assigned 0 points.
Platelet count: ≥ 350,000/μL receives 1 point.
Hemoglobin levels: White blood cell count: > 11,000/μL receives 1 point.
Body mass index (BMI): ≥ 35 kg/m² receives 1 point.
The total score is calculated by summing the points for each risk factor, with higher scores indicating a greater risk of VTE.
Low Risk: 0 points (7% risk of VTE)
This stratification helps healthcare providers decide on the necessity and type of prophylactic treatment.
Why is the Khorana Score Important?
The significance of the Khorana Score lies in its ability to
predict VTE, a serious complication in cancer patients. VTE can lead to morbidity, prolonged hospital stays, and even mortality. By identifying high-risk patients, healthcare providers can initiate appropriate preventive measures, such as anticoagulation therapy, to reduce the incidence of VTE.
Specificity: It may not accurately predict VTE risk in all cancer types, such as brain tumors or melanoma.
Dynamic Factors: The score does not account for dynamic factors like changes in treatment or patient condition.
Generalizability: The score was primarily developed and validated in Western populations, which may limit its applicability in other demographic groups.
How is the Khorana Score Used in Clinical Practice?
The Khorana Score is often used in conjunction with other clinical judgments and diagnostic tools. For instance, high-risk patients may undergo additional imaging studies, like
Doppler ultrasound or CT scans, to detect asymptomatic VTE. Prophylactic anticoagulation may be considered for those with a high score, although the decision must be balanced against the risk of bleeding.
Recent Advances and Research
Recent research has focused on refining and updating the Khorana Score to improve its predictive power. Studies have explored integrating biomarkers, like D-dimer levels, and genetic factors into the scoring system. Moreover, ongoing trials are assessing the efficacy of novel anticoagulants in high-risk cancer patients identified by the Khorana Score.Conclusion
The Khorana Score remains a cornerstone in the management of VTE risk in cancer patients. It provides a practical, evidence-based approach to stratify patients and guide prophylactic interventions. However, healthcare providers must be aware of its limitations and use it as part of a comprehensive clinical assessment.
