Khorana Score

Five-item score (Khorana 2008) using the cancer site and pre-chemotherapy blood counts and BMI. In CASSINI and AVERT, patients with a score ≥ 2 had fewer VTE with apixaban or rivaroxaban prophylaxis.

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Site of cancer

Additional criteria

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For ambulatory adults with solid tumours or lymphoma starting systemic therapy. Multiple myeloma uses its own scores (IMPEDE VTE, SAVED).

Total score

Low risk

Symptomatic VTE ≈ 0.3–0.8% over 2.5 months

Decision guide

No routine primary thromboprophylaxis. Educate on VTE symptoms.

1 section is still unanswered — counted as 0 points.

Ranges: 0 Low risk1 Intermediate risk2 Intermediate risk · score ≥ 23–6 High risk

References

Khorana AA, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-4907.
Carrier M, et al. Apixaban to prevent venous thromboembolism in patients with cancer (AVERT). N Engl J Med 2019;380:711-719.
Khorana AA, et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer (CASSINI). N Engl J Med 2019;380:720-728.
Lyon AR, et al. 2022 ESC Guidelines on cardio-oncology. Eur Heart J 2022;43:4229-4361.
Key NS, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol 2023;41:3063-3071.