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Khorana Score for Chemotherapy-Associated VTE

The Khorana score predicts symptomatic VTE in ambulatory cancer patients starting chemotherapy (0–6). Score 0 is low risk (~0.8% at 2.5 months), 1–2 intermediate (~1.8%) and ≥3 high (~7%); ASCO suggests considering primary thromboprophylaxis at a score of ≥2.

Primary cancer site: Very high risk: stomach, pancreas (2); High risk: lung, lymphoma, gynecologic, bladder, testicular (1); Other site (e.g. breast, colorectal, prostate) (0)
Platelet count (×10⁹/L or ×10³/µL)
Hemoglobin (g/dL or g/L)
Using erythropoiesis-stimulating agent (yes/no, +1)
White blood cell count (×10⁹/L or ×10³/µL)
Body mass index

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Interpretation

Result	Meaning
0	Low risk (0.3–0.8%)
1–2	Intermediate risk (1.8–2%)
≥ 3	High risk (6.7–7.1%)

Formula

Stomach/pancreas 2 · lung, lymphoma, gynecologic, bladder, testicular 1 · pre-chemo platelets ≥350 ×10⁹/L 1 · Hb <10 g/dL or ESA use 1 · WBC >11 ×10⁹/L 1 · BMI ≥35 kg/m² 1

Clinical pearls

Use pre-chemotherapy blood counts.
ASCO guidelines lower the action threshold to ≥2 for considering primary prophylaxis (CASSINI, AVERT trials).
Brain tumors and myeloma were not in the derivation; myeloma on IMiDs uses separate risk models.

Examples

khorana pancreatic cancer plt 400 hgb 9.5 wbc 8 bmi 28 no esa cancer vte risk breast cancer platelets 250 hb 13 wbc 12 bmi 36 what is the Khorana score for a lung cancer patient starting chemo

FAQ

What Khorana score warrants thromboprophylaxis?

The original paper defined ≥3 as high risk; current ASCO guidance suggests offering apixaban, rivaroxaban or LMWH at a score of ≥2 if bleeding risk is acceptable.

Which cancers score 2 points in the Khorana score?

Stomach and pancreatic cancer score 2; lung, lymphoma, gynecologic, bladder and testicular cancers score 1.

Evidence

Khorana AA et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902–7.

Hematology & Oncology · Reviewed 2026-10-14 · Methodology