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1279 Predictive Efficacy of the Khorana Score in Black Patients: Retrospective Cohort Study

Program: Oral and Poster Abstracts
Session: 332. Thrombosis and Anticoagulation: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
Research, Bleeding and Clotting, adult, Clinical Research, health outcomes research, thromboembolism, Diseases, Study Population, Human
Saturday, December 9, 2023, 5:30 PM-7:30 PM

Ogheneyoma Akpoviroro, MD1, Nathan Sauers, BSChE2*, Queeneth C Uwandu, MD1*, Oghenetejiro P Akpoviroro, MD3*, Celia M Gray4*, Maryam Castagne-Charlottin, MD5*, Elga Rodrigues, BS6*, Sara Humayun, MD1*, Sameer Ahmed, MD7 and Abdul M. Adjei, MD8*

1Internal Medicine Department, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA
2Department of Engineering, Pennsylvania State University, State College, PA
3Department of Medicine, Mater Dei Hospital, Msida, Malta
4Phenomics and Data Analytics Department, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA
5Clinical and Translational Research Department, Boston University, Boston, MA
6Boston University, Boston, MA
7Internal Medicine Department, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
8Henry Cancer Center, Wilkes Barre, PA


The Khorana score(KS) is a predictive score used to determine the risk of venous thromboembolism (VTE) in cancer(CA) patients(pts). According to the original study, a score of 1-2 was consistent with an intermediate risk(IR) for VTE (VTE risk(VTER)) of 1.8-2.0% at 2.5 months). A score of >3 was associated with a high risk(HR) of VTE (6.7-7.1% VTER at 2.5 months). Several studies have noted an increased risk of VTE in Black CA pts. The original KS study did not stratify pts based on race. We sought to determine if the Khorana score was appropriately predictive of VTE in Black CA pts at our institution, using pre-chemotherapy lab values to calculate the score.


Retrospective study. Inclusion: any CA between 01/01/2015-12/31/2021, aged 18-100 years. Exclusion: history of anticoagulation 6 months prior to CA diagnosis, history of chronic VTE, history of arterial thromboembolism. Follow-up period: 1 year post cancer diagnosis or until death if sooner.


The population was composed of 233 patients. Black pts(AA) composed 39.9%; White pts(WP) composed 60.1%. Mean age of the population was 61.3 years (standard deviation (SD) 12.4). Male patients composed 49.8%. At the time of the study 39.9% were deceased; the mean duration from CA to death was 14.5 months (SD 15.0). Most common CA stage was stage IV (21.03%); breast cancer was most prevalent (15.9%). The median follow-up time was 12.0 months (IQR 7.9). VTE occurred in 39.9%; mean cancer-to-VTE duration was 4.4 months (SD 3.2). The mean cancer-to-VTE duration in AA was 4.5 months (SD 3.4); 4.3 months (SD 3.2) in WPs.

The average Charlson comorbidity index(CCI) for the population was 3.3 (SD 2.9); there were no differences between groups when CCI was evaluated (Table 1).

The population mean Khorana score was 1.3 (SD 1.2). The Khorana score for: AA was 1.4 (SD 1.1) and 1.3 (SD 1.2) in WPs. The average Khorana scores were: AA without VTE 1.4 (SD 1.1), AA with VTE 1.5 (SD 1.1), WP without VTE 1.1 (SD 1.1), WP with VTE 1.5 (SD 1.2). There were no differences between any of these average Khorana scores (Table 1). The average population Khorana score for VTE regardless of race was 1.5 (SD 1.2) and 1.3 (1.2) for patients without VTE; this was not a significant finding (p=0.130).

The positive predictive value (PPV) of the KS was determined for each KS group by race (i.e., HR score >3, IR score 1-2, low risk(LR) score 0). AA: HR PPV 13%, IR PPV 31%, LR PPV 17%. WP: HR PPV 65%, IM PPV 54%, LR PPV 34%. These values were significantly different between AA and WP for all risk groups (p<0.001) except LR (p=0.11).

Distant metastasis occurred in 22/233 (9.4%) of the total study population. More patients with VTE had distant metastasis (16/93, 17.2%) than patients without VTE (6/140, 4.3%); (OR: 4.641, 95% CI 3.7 -5.6; p=0.001).


Most patients developed VTE around 4 months following CA diagnosis. Our study shows that the KS may not be a good predictor of VTE in AA. While there was a stepwise increase in the PPV of the KS for VTE in WPs, such a pattern was not seen in AA. Pts with distant metastasis were 4.6 times more likely to have VTE.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH