KHORANAVTE Risk Assessment in Cancer Patients
Clinical & Lab Factors
Risk Profile
Low Risk
0Points
Prophylaxis Strategy
Score 0. Low risk for VTE. Routine prophylactic anticoagulation is generally not indicated.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
Clinical Use
Ambulatory cancer patients initiating a new chemotherapy regimen.
To identify patients who should receive prophylactic anticoagulation (e.g., Apixaban or Rivaroxaban).
Validated primarily for solid tumors and some lymphomas.
How it Works
The 5 Risk Factors
| Variable | Points |
|---|---|
| Very High Risk Site (Stomach, Pancreas) | 2 |
| High Risk Site (Lung, Lymphoma, Gyn, GU) | 1 |
| Platelet count ≥ 350 x 10⁹/L | 1 |
| Hemoglobin < 10 g/dL (or ESAs used) | 1 |
| WBC count > 11 x 10⁹/L | 1 |
| BMI ≥ 35 kg/m² | 1 |
VTE Risk Strata (at 6 months)
| Score | Risk Group | Probability of VTE |
|---|---|---|
| 0 | Low Risk | 0.3 - 0.8% |
| 1 - 2 | Intermediate Risk | 1.8 - 4.5% |
| ≥ 3 | High Risk | 6.7 - 12.9% |
Clinical Pearls
Primary Prophylaxis Evidence
The AVERT and CASSINI trials demonstrated that in patients with a Khorana score ≥ 2, primary thromboprophylaxis with Apixaban or Rivaroxaban significantly reduced the rate of VTE compared to placebo, with a low risk of major bleeding.
Score Limitations
The Khorana score performs less well in specific cancers like brain tumors (high intrinsic VTE risk regardless of score) and multiple myeloma (where different risk models like SAVED/IMPROVE are used).
The Evidence
Key Reference
Development and validation of a predictive model for chemotherapy-associated thrombosis
Khorana AA et al. • Blood. 2008;111(10):4902-7
Last Comprehensive Review: 2026