The Khorana score for prediction of venous thromboembolism in cancer patients: a systematic review and meta-analysis

We aimed to evaluate the performance of the Khorana score in predicting venous thromboembolic events in ambulatory cancer patients. Embase and MEDLINE were searched from January 2008 to June 2018 for studies which evaluated the Khorana score. Two authors independently screened studies for eligibility, extracted data, and assessed risk of bias. Additional data on the 6-month incidence of venous thromboembolism were sought by contacting corresponding authors. The incidence in each Khorana score risk group was estimated with random effects meta-analysis. A total of 45 articles and 8 abstracts were included, comprising 55 cohorts enrolling 34,555 ambulatory cancer patients. For 27,849 patients (81%), 6-month follow-up data were obtained. Overall, 19% of patients had a Khorana score of 0 points, 64% a score of 1 or 2 points, and 17% a score of 3 or more points. The incidence of venous thromboembolism in the first 6 months was 5.1% (95% CI 3.9-6.5) in patients with a low-risk Khorana score (0 points), 6.6% (95% CI 5.6-7.7) in those with an intermediate-risk Khorana score (1 or 2 points), and 11.0% (95% CI 8.8-13.8) in those with a high-risk Khorana score (3 points or higher). Of the patients with venous thromboembolism in the first 6 months, 23.4% (95% CI 18.4 to 29.4) had been classified as high risk according to the Khorana score (3 points or higher). In conclusion, the Khorana score can be used to select ambulatory cancer patients at high risk of VTE for thromboprophylaxis, however, most events occur outside this high-risk group.