Nick van Es1,2, Matthew Ventresca2, Marcello Di Nisio3, Qi Zhou2, Simon Noble4, Mark Crowther2,5, Matthias Briel2,6, David Garcia7, Gary H Lyman7,8, Fergus Macbeth9, Gareth Griffiths9,10, Alfonso Iorio2,11, Lawrence Mbuagbaw1,12, Ignacio Neumann2,13, Jan Brozek2, Gordon Guyatt2, Michael B Streiff14, Tejan Baldeh2, Ivan D Florez2,15, Ozlem Gurunlu Alma16, Giancarlo Agnelli17, Walter Ageno18, Maura Marcucci2, George Bozas19, Gilbert Zulian20, Anthony Maraveyas21, Bernard Lebeau22, Ramon Lecumberri23, Kostandinos Sideras24, Charles Loprinzi24, Robert McBane24, Uwe Pelzer25, Hanno Riess26, Ziad Solh27, James Perry28,29, Lara A Kahale2,30, Patrick M Bossuyt31, Clara Klerk32, Harry R Büller1, Elie A Akl2,30, Holger J Schünemann2,5. 1. Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands. 2. Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada. 3. Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy. 4. Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK. 5. Department of Medicine, McMaster University, Hamilton, ON, Canada. 6. Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland. 7. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 8. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 9. Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK. 10. Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK. 11. Division of Hematology, Department of Medicine, Hamilton, ON, Canada. 12. Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada. 13. Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 14. Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 15. Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia. 16. Department of Statistics, Mugla Sitki Kocman University, Mugla, Turkey. 17. Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy. 18. Department of Medicine and Surgery, University of Insubria, Varese, Italy. 19. Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Cottingham, UK. 20. Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland. 21. Division of Cancer-Hull York Medical School, University of Hull, Hull, UK. 22. Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 23. Hematology Service, University Clinic of Navarra, Pamplona, Spain. 24. Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA. 25. Division of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt Universität-Universität zu Berlin, Berlin, Germany. 26. Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany. 27. Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 28. Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada. 29. Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada. 30. Department of Internal Medicine, American University of Beirut, Beirut, Lebanon. 31. Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands. 32. Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands.
Abstract
BACKGROUND: Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. OBJECTIVE: To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. METHODS: This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. RESULTS: A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancer patients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6; Pinteraction = .002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). CONCLUSION: The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.
BACKGROUND: Oncology guidelines suggest using the Khorana score to select ambulatory cancerpatients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. OBJECTIVE: To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. METHODS: This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. RESULTS: A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancerpatients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6; Pinteraction = .002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). CONCLUSION: The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.
Authors: Floris T M Bosch; Frits I Mulder; Pieter Willem Kamphuisen; Saskia Middeldorp; Patrick M Bossuyt; Harry R Büller; Nick van Es Journal: Blood Adv Date: 2020-10-27
Authors: Manar Mosaad; Mohamed Hassan Elnaem; Ejaz Cheema; Ismail Ibrahim; Jamalludin Ab Rahman; Ahlam Naila Kori; How Soon Hin Journal: Int J Gen Med Date: 2021-07-24