The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis.

Anticoagulants / adverse effects Hemorrhage Heparin, Low-Molecular-Weight / therapeutic use Humans Neoplasms / complications Venous Thromboembolism / diagnosis
Khorana score cancer heparin individual participant data meta-analysis thromboprophylaxis venous thromboembolism

Journal

Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508

Informations de publication

Date de publication:
08 2020
Historique:
received: 26 02 2020
revised: 21 03 2020
accepted: 30 03 2020
pubmed: 27 4 2020
medline: 15 5 2021
entrez: 27 4 2020
Statut: ppublish

Résumé

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. 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. This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. 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; P 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.

Sections du résumé

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; P
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.

Identifiants

DOI: 10.1111/jth.14824 PMID: 32336010
pubmed: 32336010
doi: 10.1111/jth.14824
pii: S1538-7836(22)01590-2
doi:

Substances chimiques

Anticoagulants 0
Heparin, Low-Molecular-Weight 0

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1940-1951

Subventions

Organisme : Marie Curie
ID : MCCC-FCO-11-C
Pays : United Kingdom
Organisme : CIHR
ID : KRS 126594
Pays : Canada

Informations de copyright

© 2020 International Society on Thrombosis and Haemostasis.

Références

Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122:1712-1723.
Petrelli F, Cabiddu M, Borgonovo K, Barni S. Risk of venous and arterial thromboembolic events associated with anti-EGFR agents: a meta-analysis of randomized clinical trials. Ann Oncol. 2012;23:1672-1679.
Nalluri SR, Chu D, Keresztes R, Zhu X, Wu S. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis. JAMA. 2008;300:2277-2285.
Mandala M, Falanga A, Roila F, Mandalà M, Falanga A, Roila F. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2011;22(Suppl 6):vi85-92.
Streiff MB, Holmstrom B, Angelini D, et al. NCCN Guidelines Insights: Cancer-Associated Venous Thromboembolic Disease, version 2.2018. J Natl Compr Canc Netw. 2018;16:1289-1303.
Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline update. J Clin Oncol. 2020;38:496-520.
Watson HG, Keeling DM, Laffan M, Tait RC, Makris M. British Committee for Standards in Haematology. Guideline on aspects of cancer-related venous thrombosis. Br J Haematol. 2015;170:640-648.
Farge D, Frere C, Connors JM, et al. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2019;20:e566-e581.
Moore RA, Adel N, Riedel E, et al. High incidence of thromboembolic events in patients treated with cisplatin-based chemotherapy: a large retrospective analysis. J Clin Oncol. 2011;29:3466-3473.
Ay C, Dunkler D, Marosi C, et al. Prediction of venous thromboembolism in cancer patients. Blood. 2010;116:5377-5382.
van Es N, Franke VF, Middeldorp S, Wilmink JW, Büller HR. The Khorana score for the prediction of venous thromboembolism in patients with pancreatic cancer. Thromb Res. 2017;150:30-32.
Tully CM, Apolo AB, Zabor EC, et al. The high incidence of vascular thromboembolic events in patients with metastatic or unresectable urothelial cancer treated with platinum chemotherapy agents. Cancer. 2016;122:712-721.
Noble S, Alikhan R, Robbins A, Macbeth F, Hood K. Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer: comment. J Thromb Haemost. 2017;15:590-591.
Schünemann HJ, Ventresca M, Crowther M, et al. Use of heparins in patients with cancer: individual participant data meta-analysis of randomised trials study protocol. BMJ Open. 2016;6:e010569.
Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158:280-286.
Spencer FA, Iorio A, You J, et al. Uncertainties in baseline risk estimates and confidence in treatment effects. BMJ. 2012;345:e7401.
Iorio A, Spencer FA, Falavigna M, et al. Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients. BMJ. 2015;350:h870.
Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383-394.
Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 2008;111:4902-4907.
Debray TPA, Damen JAAG, Snell KIE, et al. A guide to systematic review and meta-analysis of prediction model performance. BMJ. 2017;356:i6460.
Kuderer NM, Poniewierski MS, Culakova E, et al. Predictors of Venous thromboembolism and early mortality in lung cancer: results from a global prospective study (CANTARISK). Oncologist. 2018;23:247-255.
Debray TPA, Moons KGM, Abo-Zaid GMA, Koffijberg H, Riley RD. Individual participant data meta-analysis for a binary outcome: one-stage or two-stage? PLoS ONE. 2013;8:e60650.
Carrier M, Abou-Nassar K, Mallick R, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med. 2019;380(8):711-719.
Khorana AA, Soff GA, Kakkar AK, et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med. 2019;380:720-728.
Haas SK, Freund M, Heigener D, et al. Low-molecular-weight heparin versus placebo for the prevention of venous thromboembolism in metastatic breast cancer or stage III/IV lung cancer. Clin Appl Thromb Hemost. 2012;18:159-165.
Agnelli G, George DJ, Kakkar AK, et al. Semuloparin for thromboprophylaxis in patients receiving chemotherapy for cancer. N Engl J Med. 2012;366:601-609.
Macbeth F, Noble S, Evans J, et al. Randomized phase III trial of standard therapy plus low molecular weight heparin in patients with lung cancer: FRAGMATIC trial. J Clin Oncol. 2015;34:1-10.
Pelzer U, Opitz B, Deutschinoff G, et al. Efficacy of prophylactic low-molecular weight heparin for ambulatory patients with advanced pancreatic cancer: outcomes from the CONKO-004 trial. J Clin Oncol. 2015;33:2028-2034.
Perry JR, Julian JA, Laperriere NJ, et al. PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost. 2010;8:1959-1965.
Lecumberri R, López Vivanco G, Font A, et al. Adjuvant therapy with bemiparin in patients with limited-stage small cell lung cancer: results from the ABEL study. Thromb Res. 2013;132:666-670.
Klerk CPW, Smorenburg SM, Otten HM, et al. The effect of low molecular weight heparin on survival in patients with advanced malignancy. J Clin Oncol. 2005;23:2130-2135.
van Doormaal FF, Di Nisio M, Otten HM, Richel DJ, Prins M, Buller HR. Randomized trial of the effect of the low molecular weight heparin nadroparin on survival in patients with cancer. J Clin Oncol. 2011;29:2071-2076.
Altinbas M, Coskun HS, Er O, et al. A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer. J Thromb Haemost. 2004;2:1266-1271.
Lebeau B, Chastang C, Brechot JM, et al. Subcutaneous heparin treatment increases survival in small cell lung cancer. “Petites Cellules” Group. Cancer. 1994;74:38-45.
Weber C, Merminod T, Herrmann FR, Zulian GB. Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study. Support Care Cancer. 2008;16:847-852.
Maraveyas A, Waters J, Roy R, et al. Gemcitabine versus gemcitabine plus dalteparin thromboprophylaxis in pancreatic cancer. Eur J Cancer. 2012;48:1283-1292.
Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692-694.
Khorana AA, O’Connell C, Agnelli G, Liebman HA, Lee AYY. Subcommittee on Hemostasis and Malignancy of the SSC of the ISTH. Incidental venous thromboembolism in oncology patients. J Thromb Haemost. 2012;10:2602-2604.
Srikanthan A, Tran B, Beausoleil M, et al. Large retroperitoneal lymphadenopathy as a predictor of venous thromboembolism in patients with disseminated germ cell tumors treated with chemotherapy. J Clin Oncol. 2015;33:582-587.
Ades S, Kumar S, Alam M, et al. Tumor oncogene (KRAS) status and risk of venous thrombosis in patients with metastatic colorectal cancer. J Thromb Haemost. 2015;13:998-1003.
van Es N, Di Nisio M, Cesarman G, et al. Comparison of risk prediction scores for venous thromboembolism in cancer patients: a prospective cohort study. Haematologica. 2017;102:1494-1501.
Muñoz Martín AJ, García Alfonso P, Rupérez Blanco AB, Pérez Ramírez S, Blanco Codesido M, Martín JM. Incidence of venous thromboembolism (VTE) in ambulatory pancreatic cancer patients receiving chemotherapy and analysis of Khorana’s predictive model. Clin Transl Oncol. 2014;16:927-930.
Wang Y, Attar BM, Fuentes HE, Yu J, Zhang H, Tafur AJ. Performance of Khorana risk score for prediction of venous thromboembolism in patients with hepatocellular carcinoma. Clin Appl Thromb. 2017;24:471-476.
Mansfield AS, Tafur AJ, Wang CE, Kourelis TV, Wysokinska EM, Yang P. Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer. J Thromb Haemost. 2016;14:1773-1778.
Mulder FI, Candeloro M, Kamphuisen PW, et al. The Khorana score for prediction of venous thromboembolism in cancer patients: a systematic review and meta-analysis. Haematologica. 2019;104:1277-1287.
Bleker SM, van Es N, Kleinjan A, et al. Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis. J Thromb Haemost. 2016;14(5):973-981.
Ay C, Dunkler D, Simanek R, et al. Prediction of venous thromboembolism in patients with cancer by measuring thrombin generation: results from the Vienna Cancer and Thrombosis Study. J Clin Oncol. 2011;29:2099-2103.
Pelzer U, Sinn M, Stieler J, Riess H. [Primary pharmacological prevention of thromboembolic events in ambulatory patients with advanced pancreatic cancer treated with chemotherapy?]. Dtsch Med Wochenschr. 2013;138:2084-2088.
Verso M, Agnelli G, Barni S, Gasparini G, LaBianca R. A modified Khorana risk assessment score for venous thromboembolism in cancer patients receiving chemotherapy: the Protecht score. Intern Emerg Med. 2012;7:291-292.
Gerotziafas GT, Taher A, Abdel-Razeq H, et al. A predictive score for thrombosis associated with breast, colorectal, lung, or ovarian cancer: the prospective COMPASS-cancer-associated thrombosis study. Oncologist. 2017;22:1222-1231.

Auteurs

Nick van Es (N)

Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Matthew Ventresca (M)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Marcello Di Nisio (M)

Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy.
ORCID: 0000-0001-5930-7304

Qi Zhou (Q)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Simon Noble (S)

Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK.

Mark Crowther (M)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.

Matthias Briel (M)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland.

David Garcia (D)

Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.

Gary H Lyman (GH)

Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Fergus Macbeth (F)

Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK.

Gareth Griffiths (G)

Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK.
Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK.

Alfonso Iorio (A)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Division of Hematology, Department of Medicine, Hamilton, ON, Canada.
ORCID: 0000-0002-3331-8766

Lawrence Mbuagbaw (L)

Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada.

Ignacio Neumann (I)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

Jan Brozek (J)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Gordon Guyatt (G)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Michael B Streiff (MB)

Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Tejan Baldeh (T)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Ivan D Florez (ID)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia.
ORCID: 0000-0002-0751-8932

Ozlem Gurunlu Alma (O)

Department of Statistics, Mugla Sitki Kocman University, Mugla, Turkey.

Giancarlo Agnelli (G)

Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy.

Walter Ageno (W)

Department of Medicine and Surgery, University of Insubria, Varese, Italy.

Maura Marcucci (M)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

George Bozas (G)

Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Cottingham, UK.
ORCID: 0000-0003-1749-4855

Gilbert Zulian (G)

Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland.

Anthony Maraveyas (A)

Division of Cancer-Hull York Medical School, University of Hull, Hull, UK.
ORCID: 0000-0003-4176-5176

Bernard Lebeau (B)

Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.

Ramon Lecumberri (R)

Hematology Service, University Clinic of Navarra, Pamplona, Spain.

Kostandinos Sideras (K)

Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA.

Charles Loprinzi (C)

Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA.

Robert McBane (R)

Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA.

Uwe Pelzer (U)

Division of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt Universität-Universität zu Berlin, Berlin, Germany.

Hanno Riess (H)

Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany.

Ziad Solh (Z)

Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

James Perry (J)

Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada.
Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada.

Lara A Kahale (LA)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.

Patrick M Bossuyt (PM)

Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands.

Clara Klerk (C)

Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands.

Harry R Büller (HR)

Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.

Elie A Akl (EA)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.

Holger J Schünemann (HJ)

Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
ORCID: 0000-0003-3211-8479

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › The Khorana score for prediction of venous...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › The Khorana score for prediction of venous...
questionsmedicales.fr › Glucides › Polyosides › Glycosaminoglycanes › Héparine › Héparine bas poids moléculaire › The Khorana score for prediction of venous...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The Khorana score for prediction of venous...
questionsmedicales.fr › Tumeurs › The Khorana score for prediction of venous...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thromboembolie › Thromboembolisme veineux › The Khorana score for prediction of venous...