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Thromb Haemost 2017; 117(06): 1192-1198
DOI: 10.1160/TH16-11-0840
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Predictors of active cancer thromboembolic outcomes

RIETE experience of the Khorana score in cancer-associated thrombosis
Alfonso J. Tafur
1   NorthShore University Health Systems, Evanston, Illinois, USA
,
Joseph A. Caprini
1   NorthShore University Health Systems, Evanston, Illinois, USA
,
Lauren Cote
1   NorthShore University Health Systems, Evanston, Illinois, USA
,
Javier Trujillo-Santos
2   Department of Internal Medicine, Hospital General Universitario Santa Lucia, Murcia, Spain
,
Jorge Del Toro
3   Department of Internal Medicine, Hospital General Universitario Gregorio Maranon, Madrid, Spain
,
Fernando Garcia-Bragado
4   Department of Internal Medicine, Hospital Universitari de Girona Dr Josep Trueta, Gerona, Spain
,
Carles Tolosa
5   Department of Internal Medicine, Corporación Sanitaria Parc Tauli, Barcelona, Spain
,
Giovanni Barillari
6   Department of Internal Medicine, Ospedale S.Maria della Misericordia, Udine, Italy
,
Adriana Visona
7   Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
,
Manuel Monreal
8   Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universidad Católica de Murcia, Spain
,
the RIETE Investigators › Author Affiliations
Further Information

Publication History

Received: 07 November 2016

Accepted after major revision: 23 February 2017

Publication Date:
28 November 2017 (online)

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Summary

Even though the Khorana risk score (KRS) has been validated to predict against the development of VTE among patients with cancer, it has a low positive predictive value. It is also unknown whether the score predicts outcomes in patients with cancer with established VTE. We selected a cohort of patients with active cancer from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to assess the prognostic value of the KRS at inception in predicting the likelihood of VTE recurrences, major bleeding and mortality during the course of anticoagulant therapy. We analysed 7948 consecutive patients with cancer-associated VTE. Of these, 2253 (28 %) scored 0 points, 4550 (57 %) 1–2 points and 1145 (14 %) scored ≥3 points. During the course of anticoagulation, amongst patient with low, moderate and high risk KRS, the rate of VTE recurrences was of 6.21 (95 %CI: 4.99–7.63), 11.2 (95 %CI: 9.91–12.7) and 19.4 (95 %CI: 15.4–24.1) events per 100 patient-years; the rate of major bleeding of 5.24 (95 %CI: 4.13–6.56), 10.3 (95 %CI: 9.02–11.7) and 19.4 (95 %CI: 15.4–24.1) bleeds per 100 patient-years and the mortality rate of 25.3 (95 %CI: 22.8–28.0), 58.5 (95 %CI: 55.5–61.7) and 120 (95 %CI: 110–131) deaths per 100 patient-years, respectively. The C-statistic was 0.53 (0.50–0.56) for recurrent VTE, 0.56 (95 %CI: 0.54–0.59) for major bleeding and 0.54 (95 %CI: 0.52–0.56) for death. In conclusion, most VTEs occur in patients with low or moderate risk scores. The KRS did not accurately predict VTE recurrence, major bleeding, or mortality among patients with cancer-associated thrombosis.

Keywords

Cancer - venous thrombosis - mortality - prediction - recurrences

* A full list of the RIETE Investigators appears in the Appendix.


 

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