Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Clinical tool

Khorana Score (Cancer-Associated Thrombosis Risk)

Which patient starting chemotherapy needs thromboprophylaxis?

Updated: 27 October 20261 min read4 references

Risk of venous thrombosis in outpatients starting chemotherapy.

Cancer site

This calculator needs JavaScript; the formula and its interpretation are in the text of this page.

An aid for clinicians; it does not replace clinical judgement, local protocols or the drug label. Double-check every result before prescribing.

Score and evidence

The Khorana score adds five pre-chemotherapy variables: cancer site, platelets, haemoglobin, white cell count and BMI [1]. In two large trials of patients scoring 2 or more, apixaban 2.5 mg twice daily reduced thrombosis from about 10.2% to 4.2% but increased major bleeding from 1.8% to 3.5% [3]; rivaroxaban 10 mg daily did not differ significantly overall but reduced thrombosis while patients were on the drug [4].

ASCO 2023 recommendation: offer apixaban, rivaroxaban or low-molecular-weight heparin to high-risk outpatients (Khorana 2 or more) starting chemotherapy if they have no high bleeding risk or major drug interactions [2]. In myeloma on thalidomide or lenalidomide, aspirin or heparin according to risk [2].

Caution with bleeding

With unresected gastrointestinal or genitourinary cancers, low platelets or renal failure, the bleeding risk of oral anticoagulants is higher. More in the cancer-associated thrombosis lesson.

Related cancer types

Stomach cancerLung cancerPancreatic cancerLymphoma

Treatment regimens (physicians)

FOLFOX (mFOLFOX6): dose, schedule and side effectsCAPOX (XELOX): dose, schedule and side effectsFOLFIRI regimen: dose, schedule and side effectsFOLFIRINOX and mFOLFIRINOX: dose and side effectsGemcitabine with nab-paclitaxel: dose and scheduleFLOT regimen: dose and schedule in gastric and oesophageal cancerGemcitabine-cisplatin with durvalumab in biliary tract cancerNivolumab with CAPOX or FOLFOX in gastric cancer (CheckMate 649)Trastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringCarboplatin, pemetrexed and pembrolizumab (KEYNOTE-189)Carboplatin, paclitaxel and pembrolizumab (KEYNOTE-407)Carboplatin-etoposide with atezolizumab or durvalumab in small cell lung cancer

Physician tools and lessons

Cumulative Anthracycline Dose and Doxorubicin EquivalentsTumour Lysis Syndrome: Cairo-Bishop Criteria and PreventionHCT-CI Comorbidity Index Before Stem Cell TransplantationIPI, R-IPI, NCCN-IPI and CNS-IPI Calculator for DLBCLFollicular Lymphoma International Prognostic Index (FLIPI) CalculatorInternational Prognostic Score (IPS) for Advanced Hodgkin LymphomaMantle Cell Lymphoma International Prognostic Index (MIPI) CalculatorShould I Be Screened for Lung Cancer? (Pack-Year Calculator)Indications for haematopoietic stem cell transplantation, donor selection and conditioningGraft-versus-host disease (GVHD): prophylaxis, grading and treatment

References

4 references
Show all references, 2 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Development and validation of a predictive model for chemotherapy-associated thrombosisKhorana AA, Kuderer NM, Culakova E, et al · Blood · 2008;111:4902-7
    DOIPubMed Back to text
  2. 2
    Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline UpdateKey NS, Khorana AA, Kuderer NM, et al · J Clin Oncol · 2023;41:3063-3071
    DOIPubMed Back to text: 1 2
  3. 3
    Apixaban to Prevent Venous Thromboembolism in Patients with CancerCarrier M, Abou-Nassar K, Mallick R, et al · N Engl J Med · 2019;380:711-719
    Study cardDOIPubMed Back to text
  4. 4
    Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with CancerKhorana AA, Soff GA, Kakkar AK, et al · N Engl J Med · 2019;380:720-728
    Study cardDOIPubMed Back to text

This page is based on reputable scientific sources and was last updated on 27 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/tools/khorana-score/

Related pages

27 October 2026 CARG Score: Chemotherapy Toxicity Risk in Older Adults CARG score calculator to predict severe chemotherapy toxicity in older adults with cancer, with the ASCO recommendation for geriatric assessment. 27 October 2026 G8 Geriatric Screening Before Cancer Treatment The G8 questionnaire to screen older adults with cancer before treatment; a score of 14 or less indicates the need for a comprehensive geriatric assessment. 27 October 2026 ECOG and Karnofsky Performance Status Table and tool for patient performance status on the ECOG and Karnofsky (KPS) scales and what it means for cancer treatment decisions.